Basic Information
| Provider Information | |||||||||
| NPI: | 1871533109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | OSSAMA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000-2449 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191952449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187527282 | ||||||||
| FaxNumber: | 7187521837 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 GREENPOINT AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112222274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187527282 | ||||||||
| FaxNumber: | 7187521837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 196881 | NY | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 01810411 | 05 | NY | MEDICAID |