Provider Demographics
NPI:1841591997
Name:SAMUEL BORIS DRASSINOWER, M.D., P.C.
Entity Type:Organization
Organization Name:SAMUEL BORIS DRASSINOWER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BORIS
Authorized Official - Last Name:DRASSINOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-682-0448
Mailing Address - Street 1:15 LAKE ST # LB1
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3851
Mailing Address - Country:US
Mailing Address - Phone:914-682-0448
Mailing Address - Fax:914-682-0506
Practice Address - Street 1:15 LAKE ST # LB1
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3851
Practice Address - Country:US
Practice Address - Phone:914-682-0448
Practice Address - Fax:914-682-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1055782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13468Medicare UPIN