Healthcare Provider Details

I. General information

NPI: 1609872555
Provider Name (Legal Business Name): SAMUEL E EPSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 BEACON AVE
MANAHAWKIN NJ
08050-2418
US

IV. Provider business mailing address

1168 BEACON AVE
MANAHAWKIN NJ
08050-2418
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-6092
  • Fax: 609-597-7458
Mailing address:
  • Phone: 609-597-6092
  • Fax: 609-597-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMB51223
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: