Healthcare Provider Details

I. General information

NPI: 1982923124
Provider Name (Legal Business Name): SAMUEL HS THE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ORIENT WAY STE BB
RUTHERFORD NJ
07070-2145
US

IV. Provider business mailing address

130 ORIENT WAY STE BB
RUTHERFORD NJ
07070-2145
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6916
  • Fax: 201-438-4227
Mailing address:
  • Phone: 201-343-6916
  • Fax: 201-438-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA32800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA32800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIEM THE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 201-693-1790