Provider Demographics
NPI:1790783280
Name:SAMUELS, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SAMUELS
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 1:500 MONTAUK HWY
Mailing Address - Street 2:SUITE S
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4418
Mailing Address - Country:US
Mailing Address - Phone:631-587-7733
Mailing Address - Fax:631-587-7798
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE S
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-587-7733
Practice Address - Fax:631-587-7798
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00433587Medicaid
C05405Medicare UPIN
10A991Medicare ID - Type Unspecified