Healthcare Provider Details

I. General information

NPI: 1316623895
Provider Name (Legal Business Name): DR. SAMUEL METZGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 ROCHAMBEAU AVE FL 2
BRONX NY
10467-2836
US

IV. Provider business mailing address

5883 NW 25TH CT
BOCA RATON FL
33496-2230
US

V. Phone/Fax

Practice location:
  • Phone: 732-379-7489
  • Fax:
Mailing address:
  • Phone: 732-379-7489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03112200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: