Provider Demographics
NPI:1689691438
Name:TOUEG, SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:TOUEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:TOUEG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:ROOM A1-16
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-2490
Mailing Address - Fax:718-334-5845
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ROOM A1-16
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-2490
Practice Address - Fax:718-334-5845
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01201174Medicaid
NY01201174Medicaid
NY01201174Medicaid