Provider Demographics
NPI:1629144084
Name:SAMUELS, FRANCINE (MD)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:SAMUELS
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 1:601 W 57TH ST APT 33Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1095
Mailing Address - Country:US
Mailing Address - Phone:551-996-8840
Mailing Address - Fax:201-441-9949
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:551-996-8840
Practice Address - Fax:201-441-9949
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084058002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234935OtherLICENSE