Healthcare Provider Details

I. General information

NPI: 1730119926
Provider Name (Legal Business Name): EOS MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 STONELEIGH AVE
CARMEL NY
10512
US

IV. Provider business mailing address

PO BOX 11090
WESTMINSTER CA
92685-1090
US

V. Phone/Fax

Practice location:
  • Phone: 856-616-8100
  • Fax: 856-616-1919
Mailing address:
  • Phone: 562-809-3573
  • Fax: 562-468-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A SAMA
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 845-226-8045