Provider Demographics
NPI:1558750356
Name:SAMUELS, JOHN KEITH IV (BA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEITH
Last Name:SAMUELS
Suffix:IV
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 92ND ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1620
Mailing Address - Country:US
Mailing Address - Phone:646-672-1105
Mailing Address - Fax:
Practice Address - Street 1:116 E 92ND ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1620
Practice Address - Country:US
Practice Address - Phone:646-672-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)