Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date: 01/25/2017
Reactivation Date: 03/09/2017

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

100 E 77TH ST
NEW YORK NY
10075-1850
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2000
  • Fax:
Mailing address:
  • Phone: 212-434-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number315931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: