Healthcare Provider Details

I. General information

NPI: 1396770426
Provider Name (Legal Business Name): SAMMY I MASRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CENTURY RD
PARAMUS NJ
07652-1433
US

IV. Provider business mailing address

30 W CENTURY RD
PARAMUS NJ
07652-1433
US

V. Phone/Fax

Practice location:
  • Phone: 201-986-1003
  • Fax: 201-986-1680
Mailing address:
  • Phone: 201-986-1003
  • Fax: 201-986-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number25MA07567400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: