Provider Demographics
NPI:1932320736
Name:LOCATELLI, SAM THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:THOMAS
Last Name:LOCATELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:171 RIDGEDALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1764
Mailing Address - Country:US
Mailing Address - Phone:973-377-6327
Mailing Address - Fax:973-408-9055
Practice Address - Street 1:171 RIDGEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:973-377-6327
Practice Address - Fax:973-408-9055
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04783200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58411Medicare UPIN
NJ571486Medicare ID - Type Unspecified