Provider Demographics
NPI:1477729374
Name:SOSTRE, SAMUEL OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:OLIVER
Last Name:SOSTRE
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 1:450 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1503
Mailing Address - Country:US
Mailing Address - Phone:201-562-2088
Mailing Address - Fax:
Practice Address - Street 1:450 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1503
Practice Address - Country:US
Practice Address - Phone:201-562-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA081367002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0236951Medicaid
NJ188262APHMedicare PIN