Provider Demographics
NPI:1982923124
Name:SAMUEL HS THE MD PA
Entity Type:Organization
Organization Name:SAMUEL HS THE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:THE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-438-6916
Mailing Address - Street 1:33 E CENTURY RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-262-3628
Mailing Address - Fax:201-265-3646
Practice Address - Street 1:130 ORIENT WAY STE BB
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2145
Practice Address - Country:US
Practice Address - Phone:201-438-6916
Practice Address - Fax:201-438-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32800207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty