Healthcare Provider Details

I. General information

NPI: 1568439305
Provider Name (Legal Business Name): SAMUEL J. SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-04 BROADWAY GARDEN STATE ORTHOPAEDIC ASSOCIATES
FAIR LAWN NJ
07410-3913
US

IV. Provider business mailing address

28-04 BROADWAY GARDEN STATE ORTHOPAEDIC ASSOCIATES
FAIR LAWN NJ
07410-3913
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-4434
  • Fax:
Mailing address:
  • Phone: 201-791-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA0535220
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA05352200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number25MA0535220
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: