Provider Demographics
NPI:1770533572
Name:SAMSON, ISRAEL MARC (MD)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:MARC
Last Name:SAMSON
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 1:545 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2144
Mailing Address - Country:US
Mailing Address - Phone:516-791-7400
Mailing Address - Fax:516-791-7755
Practice Address - Street 1:545 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2144
Practice Address - Country:US
Practice Address - Phone:516-791-7400
Practice Address - Fax:516-791-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193386207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G68249Medicare UPIN
34N311Medicare ID - Type Unspecified