Provider Demographics
NPI:1528364353
Name:SAMANDAROV, ALBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:SAMANDAROV
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3116 30TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1571
Mailing Address - Country:US
Mailing Address - Phone:718-626-3338
Mailing Address - Fax:718-626-3034
Practice Address - Street 1:3116 30TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1571
Practice Address - Country:US
Practice Address - Phone:718-626-3338
Practice Address - Fax:718-626-3034
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery