Provider Demographics
NPI:1922153071
Name:MERRICK, SAMUEL THOMPSON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THOMPSON
Last Name:MERRICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:450 E 63RD ST
Mailing Address - Street 2:APT 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7928
Mailing Address - Country:US
Mailing Address - Phone:212-746-4180
Mailing Address - Fax:212-746-8415
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:ROOM F-24
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-4180
Practice Address - Fax:212-746-8415
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-07-14
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Provider Licenses
StateLicense IDTaxonomies
NY180705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94838Medicare UPIN