DR. SANJAY SAMUEL (NPI# 1417180852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417180852 |
| Entity Type | Individual |
| Full Name | DR. SANJAY SAMUEL |
| Credential | MD |
| Practice Address |
156 West Ave Brockport NY 14420-1229 |
| Practice Telephone | 5856373131 |
| Practice Fax Number | 5853956036 |
| Mailing Telephone | 5856373131 |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2017-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | 254678 | NY | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 254678 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
156 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1229 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942271218 | Didem Miraloglu | Internal Medicine | 156 West Ave, Suite 106, Brockport, NY 14420-1229 | 2006-01-27 |
| 1679170849 | Kelsey Covel | Nurse Practitioner | 156 West Ave, Brockport, NY 14420-1229 | 2020-10-01 |
| 1720624562 | Geena Brady | Physical Therapist | 156 West Ave, Brockport, NY 14420-1229 | 2019-11-26 |
| 1801366380 | University Orthopaedic Associates of Rochester | Orthopaedic Surgery | 156 West Ave, Brockport, NY 14420-1229 | 2018-11-28 |
| 1508302159 | Melissa Kingston | Occupational Therapist | 156 West Ave, Brockport, NY 14420-1229 | 2017-01-06 |
| 1043769326 | Emma L Leatham | Physician Assistant | 156 West Ave, Brockport, NY 14420-1229 | 2016-09-27 |
| 1679811327 | Lakeside Health System | General Acute Care Hospital | 156 West Ave, Brockport, NY 14420-1229 | 2013-01-30 |
| 1801173448 | Lakeshore Surgical Practice, PC | Surgery | 156 West Ave, Brockport, NY 14420-1229 | 2011-11-10 |
| 1952613499 | Nathaniel James Wade | Pharmacist | 156 West Ave, Pharmacy Dept, Brockport, NY 14420-1229 | 2010-07-13 |
| 1235457375 | Suri Karthikeyan Mdpc | Internal Medicine | 156 West Ave, Suite 202, Brockport, NY 14420-1229 | 2010-05-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942359989 | Lakeside Memorial Hospital Inc. | General Practice | 156 West Ave, Brockport, NY 14420 | 2007-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420472 | Theodean Smith-lawrence | General Practice | 7 Smoke Rise Ln, Wappingers Falls, NY 12590-1220 | 2020-09-03 |
| 1891304325 | Christopher R. Page, M.d., Pllc | General Practice | 46 Route 25a Ste 6, Setauket, NY 11733-2807 | 2020-07-30 |
| 1740804442 | Aliza Hakimian | General Practice | 15 Hill Park Ave Apt 2n, Great Neck, NY 11021-3709 | 2020-05-29 |
| 1962022152 | Lynnette Lallave - Cortes | General Practice | 2 Seaman Ave Apt 1d, New York, NY 10034-2904 | 2020-04-17 |
| 1942829759 | Northeasttelemedicine | General Practice | 483 Coolidge Hill Rd, Diamond Point, NY 12824 | 2020-04-11 |
| 1578198826 | Online Care Medicine PC | General Practice | 26 Oldox Rd, Delmar, NY 12054-2943 | 2020-03-06 |
| 1821621301 | Donnet Andrea Riley | General Practice | 781 Palmer Rd Apt 3a, Bronxville, NY 10708-3309 | 2020-02-12 |
| 1104463652 | Ohad Shimshon Bentur | General Practice | 450 E 63rd St Apt 3g, New York, NY 10065-7957 | 2019-12-03 |
| 1285278291 | Echo Clinical Associates LLC | General Practice | 56 Echo Ave., Ste 1, Miller Place, NY 11764-2454 | 2019-11-01 |
| 1710528583 | Debra Heverly | General Practice | 2315 Whirlpool St # 415, Niagara Falls, NY 14305-2413 | 2019-10-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.