Provider Demographics
NPI:1497843858
Name:SAMUELSON, ROBERT JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JEFFREY
Last Name:SAMUELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 E 32ND ST
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5507
Mailing Address - Country:US
Mailing Address - Phone:212-879-7777
Mailing Address - Fax:646-952-3357
Practice Address - Street 1:38 E 32ND ST
Practice Address - Street 2:3 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5507
Practice Address - Country:US
Practice Address - Phone:212-879-7777
Practice Address - Fax:646-952-3357
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143427207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB14120Medicare UPIN
38D501Medicare ID - Type Unspecified