Healthcare Provider Details

I. General information

NPI: 1376283366
Provider Name (Legal Business Name): CHRISTOPHER OBINNA SAMUEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 ROUTE 17 NORTH STE 3
HACKENSACK NJ
07601
US

IV. Provider business mailing address

25 HICKORY PL APT J12
CHATHAM NJ
07928-3000
US

V. Phone/Fax

Practice location:
  • Phone: 888-212-4512
  • Fax:
Mailing address:
  • Phone: 908-377-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA13169800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: