Healthcare Provider Details

I. General information

NPI: 1215928619
Provider Name (Legal Business Name): SAMUEL E BOOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HUDSON VALLEY AVE STE 205
NEW WINDSOR NY
12553-4747
US

IV. Provider business mailing address

575 HUDSON VALLEY AVE STE 205
NEW WINDSOR NY
12553-4747
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2200
  • Fax: 845-220-2249
Mailing address:
  • Phone: 845-220-2200
  • Fax: 845-220-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number040087
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number211008
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number211008
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number211008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: