Provider Demographics
NPI:1649277294
Name:RAE, SAM (MD)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:RAE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:342 HAMBURG TPKE
Mailing Address - Street 2:STE 201
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2162
Mailing Address - Country:US
Mailing Address - Phone:973-389-1119
Mailing Address - Fax:973-389-1145
Practice Address - Street 1:342 HAMBURG TPKE
Practice Address - Street 2:STE 201
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2162
Practice Address - Country:US
Practice Address - Phone:973-389-1119
Practice Address - Fax:973-389-1145
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06232900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7163207Medicaid
NJ7163207Medicaid
NJV1524750Medicare ID - Type Unspecified