Healthcare Provider Details

I. General information

NPI: 1063668846
Provider Name (Legal Business Name): SAMMY I. MASRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
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: 201-261-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MA07567400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SAMMY I MASRI
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 201-261-2000