Provider Demographics
NPI:1396770426
Name:MASRI, SAMMY I (MD)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:I
Last Name:MASRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W CENTURY RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1433
Mailing Address - Country:US
Mailing Address - Phone:201-986-1003
Mailing Address - Fax:201-986-1680
Practice Address - Street 1:30 W CENTURY RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1433
Practice Address - Country:US
Practice Address - Phone:201-986-1003
Practice Address - Fax:201-986-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07567400204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH82983Medicare UPIN
NJ096585Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER