Provider Demographics
NPI:1295793933
Name:ALTSTEIN, SAMUEL (DO,)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ALTSTEIN
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2454
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2454
Mailing Address - Country:US
Mailing Address - Phone:212-352-2600
Mailing Address - Fax:
Practice Address - Street 1:202 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2301
Practice Address - Country:US
Practice Address - Phone:212-352-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02008280Medicaid
NY0H1741Medicare ID - Type Unspecified
NYH03887Medicare UPIN