Provider Demographics
NPI:1700884145
Name:FADDOUL, SAMI (MD)
Entity type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:FADDOUL
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 1:244 WESTCHESTER AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2900
Mailing Address - Country:US
Mailing Address - Phone:800-501-6388
Mailing Address - Fax:914-872-2470
Practice Address - Street 1:DAVIS AVE AT E POST RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4615
Practice Address - Country:US
Practice Address - Phone:914-681-1260
Practice Address - Fax:914-681-2906
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224377-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H56497Medicare UPIN
NY534581Medicare ID - Type Unspecified