Healthcare Provider Details

I. General information

NPI: 1629144084
Provider Name (Legal Business Name): FRANCINE SAMUELS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MARCUS AVE STE 201
NEW HYDE PARK NY
11042-1113
US

IV. Provider business mailing address

601 W 57TH ST APT 33Q
NEW YORK NY
10019-1095
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6076
  • Fax:
Mailing address:
  • Phone: 551-996-8840
  • Fax: 201-441-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA08405800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number234935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: