Provider Demographics
NPI:1841248234
Name:HADDAD, SAMIR (MD)
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:
Last Name:HADDAD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 ROUTE 111
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4756
Mailing Address - Country:US
Mailing Address - Phone:631-780-6804
Mailing Address - Fax:631-780-6806
Practice Address - Street 1:4700 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6025
Practice Address - Country:US
Practice Address - Phone:303-335-0062
Practice Address - Fax:303-339-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2209932084N0400X
CODR00713922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH37247Medicare UPIN
NY365N91Medicare ID - Type Unspecified