Provider Demographics
NPI:1679623797
Name:SAMUELS, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ENGLE STREET, 4 EAST
Mailing Address - Street 2:C/O DEPT OF PSYCHIATRY, ENGLEWOOD HOSP & MEDICAL CTR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-681-2915
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE STREET, 4 EAST
Practice Address - Street 2:C/O DEPT OF PSYCHIATRY, ENGLEWOOD HOSP & MEDICAL CTR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-681-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076605002084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024066Medicaid
NJG04348Medicare UPIN
NJ076410Medicare ID - Type Unspecified