Provider Demographics
NPI:1134212368
Name:SAMUELSON, SANA (MD)
Entity type:Individual
Prefix:DR
First Name:SANA
Middle Name:
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 WESTCHESTER AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5072
Mailing Address - Country:US
Mailing Address - Phone:718-409-8862
Mailing Address - Fax:718-409-8994
Practice Address - Street 1:MMG - BRONX EAST
Practice Address - Street 2:2300 WESTCHESTER AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-409-8862
Practice Address - Fax:718-409-8994
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH10367Medicare UPIN