Provider Demographics
NPI:1982979183
Name:HURLBUT, SAMUEL HUNTINGTON (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HUNTINGTON
Last Name:HURLBUT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OVERLOOK TER APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2205
Mailing Address - Country:US
Mailing Address - Phone:917-747-5677
Mailing Address - Fax:
Practice Address - Street 1:508 E 120TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3743
Practice Address - Country:US
Practice Address - Phone:212-860-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017066-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0170066-1OtherOTR/L