Basic Information
| Provider Information | |||||||||
| NPI: | 1982691580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERKHAN | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 949 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188287188 | ||||||||
| FaxNumber: | 5188285049 | ||||||||
| Practice Location | |||||||||
| Address1: | 159 JEFFERSON HTS | ||||||||
| Address2: | SUITE D107 | ||||||||
| City: | CATSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124141237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189431442 | ||||||||
| FaxNumber: | 5189432003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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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 | 207R00000X | 209006 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01682842 | 05 | NY | MEDICAID |