Healthcare Provider Details

I. General information

NPI: 1811484009
Provider Name (Legal Business Name): RUWAA SAMARRAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

188 HAMPSHIRE CT
PISCATAWAY NJ
08854-6238
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax:
Mailing address:
  • Phone: 917-363-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA12279400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: