Provider Demographics
NPI:1366687139
Name:SAMARNEH, MAJED MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJED
Middle Name:MARK
Last Name:SAMARNEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 S BROADWAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4006
Mailing Address - Country:US
Mailing Address - Phone:914-965-0621
Mailing Address - Fax:914-965-2040
Practice Address - Street 1:136 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4008
Practice Address - Country:US
Practice Address - Phone:914-965-0621
Practice Address - Fax:914-965-2040
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY263964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03461667Medicaid
NY03461667Medicaid