Healthcare Provider Details

I. General information

NPI: 1922324193
Provider Name (Legal Business Name): SAMUEL A FUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E 68TH ST OFFICE 425
NEW YORK NY
10065-5606
US

IV. Provider business mailing address

353 E 68TH ST OFFICE 425
NEW YORK NY
10065-5606
US

V. Phone/Fax

Practice location:
  • Phone: 646-422-4558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number263400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: