Provider Demographics
NPI:1619982014
Name:SAMPSON, RUBY J (MD)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:J
Last Name:SAMPSON
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 1:106 VALLEY STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SO ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079
Mailing Address - Country:US
Mailing Address - Phone:973-313-9300
Mailing Address - Fax:973-313-2313
Practice Address - Street 1:106 VALLEY STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SO ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079
Practice Address - Country:US
Practice Address - Phone:973-313-9300
Practice Address - Fax:973-313-2313
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3357805Medicaid
NJ3357805Medicaid
NJSA520370Medicare ID - Type Unspecified