Provider Demographics
NPI:1508863721
Name:SAMAHA, SOUHEIL H
Entity Type:Individual
Prefix:DR
First Name:SOUHEIL
Middle Name:H
Last Name:SAMAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SOUHEIL
Other - Middle Name:
Other - Last Name:SAMAHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:230 E 52ND ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6208
Mailing Address - Country:US
Mailing Address - Phone:212-734-4484
Mailing Address - Fax:212-743-4486
Practice Address - Street 1:54 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0305
Practice Address - Country:US
Practice Address - Phone:212-734-4484
Practice Address - Fax:212-734-4486
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205745207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG58698Medicare UPIN
NY16U991Medicare ID - Type Unspecified