Provider Demographics
NPI:1760416184
Name:RHEE, SAMUEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:RHEE
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 1:166 W END AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4116
Mailing Address - Country:US
Mailing Address - Phone:201-882-2554
Mailing Address - Fax:201-882-2556
Practice Address - Street 1:201 ROUTE 17 NORTH
Practice Address - Street 2:11TH FLOOR
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-882-2554
Practice Address - Fax:201-882-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07955900208200000X
NY209853208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100919Medicaid
NJ099571Medicare ID - Type Unspecified
I22328Medicare UPIN