Provider Demographics
NPI:1417984857
Name:DHURAIRAJ, SAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMY
Middle Name:
Last Name:DHURAIRAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-972-5370
Practice Address - Fax:973-290-7294
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47642207U00000X
NJ25MA08821600207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2378188OtherARAZ
MT0144560Medicaid
MN1044140OtherPREFERRED ONE
IA0596197Medicaid
MN16-03685OtherMEDICA CHOICE
MN16-02032OtherMEDICA PRIMARY
WI34666300Medicaid
MN610125900Medicaid
MNHP55316OtherHEALTHPARTNERS
MN135159OtherUCARE
MN503K5DHOtherBCBS
MNP00247939OtherRAIL ROAD MEDICARE
MN135159OtherUCARE
MNI35026Medicare UPIN