Healthcare Provider Details

I. General information

NPI: 1619265998
Provider Name (Legal Business Name): THE LIGHT MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CANAL ST SUITE 5001
NEW YORK NY
10013-3501
US

IV. Provider business mailing address

15 LEONELLO LANE
STATEN ISLAND NY
10307-0000
US

V. Phone/Fax

Practice location:
  • Phone: 212-287-3384
  • Fax: 212-287-0031
Mailing address:
  • Phone: 212-287-3384
  • Fax: 212-287-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number221203
License Number StateNY

VIII. Authorized Official

Name: DR. ASHRAF SAMAAN
Title or Position: OWNER
Credential: MD
Phone: 212-874-3384