Healthcare Provider Details

I. General information

NPI: 1083820518
Provider Name (Legal Business Name): SAMUEL H ENGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/23/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753-3206
US

IV. Provider business mailing address

3700 ROUTE 33 SUITE 101
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-7855
  • Fax: 732-280-7815
Mailing address:
  • Phone: 732-280-7855
  • Fax: 732-280-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD036475
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA08380800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA08380800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: