Provider Demographics
NPI:1124075460
Name:SAMADI, SHARYAR DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:SHARYAR
Middle Name:DANIEL
Last Name:SAMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:S
Other - Last Name:SAMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:130 W PLEASANT AVE
Mailing Address - Street 2:# 304
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1335
Mailing Address - Country:US
Mailing Address - Phone:201-996-1505
Mailing Address - Fax:201-996-1605
Practice Address - Street 1:10 FOREST AVE
Practice Address - Street 2:100
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5242
Practice Address - Country:US
Practice Address - Phone:201-996-1505
Practice Address - Fax:201-996-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07544200207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070015Medicare ID - Type Unspecified
NJH84956Medicare UPIN