Provider Demographics
NPI:1497515696
Name:LASSITER, SAMUEL BENNETT (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BENNETT
Last Name:LASSITER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 89TH ST APT A1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3483
Mailing Address - Country:US
Mailing Address - Phone:303-437-3266
Mailing Address - Fax:
Practice Address - Street 1:223 E 89TH ST APT A1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3483
Practice Address - Country:US
Practice Address - Phone:303-437-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program