Healthcare Provider Details

I. General information

NPI: 1437010220
Provider Name (Legal Business Name): SEASIDE EAR NOSE AND THROAT MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 3RD AVE
BROOKLYN NY
11220-5803
US

IV. Provider business mailing address

6818 3RD AVE
BROOKLYN NY
11220-5803
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: RUWAA SAMARRAI
Title or Position: DIRECTOR
Credential: MD
Phone: 917-363-6877