Healthcare Provider Details

I. General information

NPI: 1285910927
Provider Name (Legal Business Name): SAMUEL EPHRAIM BOOK, MD, FAAD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HUDSON VALLEY AVE STE 205
NEW WINDSOR NY
12553-4746
US

IV. Provider business mailing address

575 HUDSON VALLEY AVE STE 205
NEW WINDSOR NY
12553-4746
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2200
  • Fax: 845-220-2249
Mailing address:
  • Phone: 845-220-2200
  • Fax: 845-220-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number211008
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number211008
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number211008
License Number StateNY

VIII. Authorized Official

Name: SAMUEL EPHRAIM BOOK
Title or Position: OWNER
Credential: M.D.
Phone: 845-220-2200