Provider Demographics
NPI:1922316090
Name:DR RUBY J SAMPSON INC
Entity Type:Organization
Organization Name:DR RUBY J SAMPSON INC
Other - Org Name:RUBY J SAMPSON MD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANJELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-313-9300
Mailing Address - Street 1:106 VALLEY ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2886
Mailing Address - Country:US
Mailing Address - Phone:973-313-9300
Mailing Address - Fax:973-313-2313
Practice Address - Street 1:106 VALLEY ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2886
Practice Address - Country:US
Practice Address - Phone:973-313-9300
Practice Address - Fax:973-313-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3357805Medicaid
=========OtherTIN
NJ3357805Medicaid
NJSA520370Medicare PIN