Provider Demographics
NPI:1518365824
Name:SAMMY I MASRI LLC
Entity Type:Organization
Organization Name:SAMMY I MASRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-0934
Mailing Address - Street 1:37 W CENTURY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1466
Mailing Address - Country:US
Mailing Address - Phone:201-261-0402
Mailing Address - Fax:201-261-0587
Practice Address - Street 1:37 W CENTURY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1466
Practice Address - Country:US
Practice Address - Phone:201-261-0402
Practice Address - Fax:201-261-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07567400207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty