Healthcare Provider Details

I. General information

NPI: 1982979183
Provider Name (Legal Business Name): SAMUEL HUNTINGTON HURLBUT OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E 120TH ST
NEW YORK NY
10035-3743
US

IV. Provider business mailing address

10 OVERLOOK TER APT 5F
NEW YORK NY
10033-2205
US

V. Phone/Fax

Practice location:
  • Phone: 212-860-5809
  • Fax:
Mailing address:
  • Phone: 917-747-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number017066-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: