Provider Demographics
NPI:1922055276
Name:DAVIDOFF, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:DAVIDOFF
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 1:10816 72ND AVE
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5350
Mailing Address - Country:US
Mailing Address - Phone:718-261-0900
Mailing Address - Fax:718-261-0944
Practice Address - Street 1:10816 72ND AVE
Practice Address - Street 2:2 FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5350
Practice Address - Country:US
Practice Address - Phone:718-261-0900
Practice Address - Fax:718-261-0944
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229243207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427214949OtherGASTROENTEROLOGY
NY0299382Medicaid