Healthcare Provider Details

I. General information

NPI: 1811283617
Provider Name (Legal Business Name): SAMUEL SHAJNFELD RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

4200 SUNRISE HWY
MASSAPEQUA NY
11758-5311
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-8880
  • Fax: 908-277-8796
Mailing address:
  • Phone: 516-541-1064
  • Fax: 516-798-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014684
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00419900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: