Healthcare Provider Details

I. General information

NPI: 1417984857
Provider Name (Legal Business Name): SAMY DHURAIRAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

465 SOUTH ST
MORRISTOWN NJ
07960-6442
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5370
  • Fax: 973-290-7294
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number47642
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number25MA08821600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA08821600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: