Provider Demographics
NPI:1982646782
Name:SAMIE, FARAMARZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:SAMIE
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 1:161 FORT WASHINGTON AVE FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-342-1321
Mailing Address - Fax:212-305-4571
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-342-1321
Practice Address - Fax:212-305-4571
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15491207N00000X
PAMD431602207N00000X
NY239725207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019789Medicaid
NJ0134996Medicaid
PA101931308Medicaid
NH32001013Medicaid
VT1019789Medicaid
NJ0134996Medicaid
NH002424301Medicare PIN