Provider Demographics
NPI:1851499206
Name:SOUNDVIEW MEDICAL PHYSICIAN PC
Entity Type:Organization
Organization Name:SOUNDVIEW MEDICAL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARNEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-991-7330
Mailing Address - Street 1:609 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2945
Mailing Address - Country:US
Mailing Address - Phone:718-991-7330
Mailing Address - Fax:
Practice Address - Street 1:609 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2945
Practice Address - Country:US
Practice Address - Phone:718-991-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03425156Medicaid
NY01642479Medicaid
NY01642479Medicaid