Provider Demographics
NPI:1295898732
Name:CARR, SAMUEL S (DPM)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:CARR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BARKER AVE
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1509
Mailing Address - Country:US
Mailing Address - Phone:914-949-7900
Mailing Address - Fax:914-949-1245
Practice Address - Street 1:3 BARKER AVE
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1509
Practice Address - Country:US
Practice Address - Phone:914-949-7900
Practice Address - Fax:914-949-1245
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005242-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01643741Medicaid
NY01643741Medicaid
NYA400058016Medicare PIN
NYG400056114Medicare PIN
NYJ400051856Medicare PIN
U58646Medicare UPIN