Provider Demographics
NPI:1295796035
Name:SAMSEL, JAMES (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SAMSEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2810
Mailing Address - Country:US
Mailing Address - Phone:315-434-9353
Mailing Address - Fax:315-434-5581
Practice Address - Street 1:222 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2810
Practice Address - Country:US
Practice Address - Phone:315-434-9353
Practice Address - Fax:315-434-5581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1742Medicare ID - Type UnspecifiedMEDICARE NUMBER