Healthcare Provider Details

I. General information

NPI: 1053355255
Provider Name (Legal Business Name): SAMUEL LOUIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST ORANGE REGIONAL MEDICAL CENTER
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

535 E CRESCENT AVE C/O HISTOPATHOLOGY SERVICES, LLC
RAMSEY NJ
07446-2922
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-0089
  • Fax: 201-661-7297
Mailing address:
  • Phone: 201-661-7280
  • Fax: 201-661-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number137846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: