Provider Demographics
NPI:1982820809
Name:ELLIOTT SAMET MD, PC
Entity Type:Organization
Organization Name:ELLIOTT SAMET MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-591-1600
Mailing Address - Street 1:160 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4716
Mailing Address - Country:US
Mailing Address - Phone:973-591-1600
Mailing Address - Fax:973-591-1605
Practice Address - Street 1:160 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4716
Practice Address - Country:US
Practice Address - Phone:973-591-1600
Practice Address - Fax:973-591-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07236300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty