Healthcare Provider Details

I. General information

NPI: 1538803200
Provider Name (Legal Business Name): STEFAN T. SAMUELSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 W 24TH ST FL 4
NEW YORK NY
10010-3570
US

IV. Provider business mailing address

49 W 24TH ST FL 4
NEW YORK NY
10010-3570
US

V. Phone/Fax

Practice location:
  • Phone: 212-993-8573
  • Fax:
Mailing address:
  • Phone: 212-594-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEFAN SAMUELSON
Title or Position: OWNER
Credential: MD
Phone: 212-594-1600