Healthcare Provider Details

I. General information

NPI: 1336355403
Provider Name (Legal Business Name): SAMUEL SEBASTIANNE SOSTRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80TH ST & 41ST AVE
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

530 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861-3654
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-3900
  • Fax: 718-334-5958
Mailing address:
  • Phone: 732-324-5138
  • Fax: 732-324-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number227974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: