Healthcare Provider Details

I. General information

NPI: 1821262585
Provider Name (Legal Business Name): ROYA R SAMUELS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 SEAGIRT BLVD
FAR ROCKAWAY NY
11691-5614
US

IV. Provider business mailing address

212 BEACH 13TH ST STE 301
FAR ROCKAWAY NY
11691-5614
US

V. Phone/Fax

Practice location:
  • Phone: 516-696-9540
  • Fax: 516-696-9541
Mailing address:
  • Phone: 718-407-7300
  • Fax: 347-735-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244414-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: