Provider Demographics
NPI:1467880989
Name:SAMUEL A AGAHIU MD PLLC
Entity Type:Organization
Organization Name:SAMUEL A AGAHIU MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:AMINU
Authorized Official - Last Name:AGAHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-248-2102
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-0233
Mailing Address - Country:US
Mailing Address - Phone:518-248-2102
Mailing Address - Fax:
Practice Address - Street 1:1 ALAN RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6047
Practice Address - Country:US
Practice Address - Phone:518-248-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249859207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty