Provider Demographics
NPI:1598717795
Name:MAPP, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MAPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3324
Mailing Address - Country:US
Mailing Address - Phone:201-433-6500
Mailing Address - Fax:201-433-8010
Practice Address - Street 1:679 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3324
Practice Address - Country:US
Practice Address - Phone:201-433-6500
Practice Address - Fax:201-433-8010
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07013900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8198802Medicaid
NJH13544Medicare UPIN
NJ037028Medicare ID - Type Unspecified
NJ037028 MVHMedicare PIN