Healthcare Provider Details

I. General information

NPI: 1083063531
Provider Name (Legal Business Name): GHASSAN SAMAHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date: 01/25/2017
Reactivation Date: 03/09/2017

III. Provider practice location address

860 E BROADWAY APT 3M
LONG BEACH NY
11561-4710
US

IV. Provider business mailing address

860 E BROADWAY APT 3M
LONG BEACH NY
11561-4710
US

V. Phone/Fax

Practice location:
  • Phone: 929-310-7066
  • Fax:
Mailing address:
  • Phone: 929-310-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM-2404
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-24694
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-2404
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: