Provider Demographics
NPI:1598822389
Name:SHAMI, SAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:SHAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 STATE ROUTE 35
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5919
Mailing Address - Country:US
Mailing Address - Phone:732-450-0820
Mailing Address - Fax:
Practice Address - Street 1:225 STATE ROUTE 35
Practice Address - Street 2:SUITE 201
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5919
Practice Address - Country:US
Practice Address - Phone:732-450-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07865800207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ138914Medicare PIN