Healthcare Provider Details

I. General information

NPI: 1972895217
Provider Name (Legal Business Name): MAHENDRANAUTH SAMARU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST M312
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST M312
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax: 212-746-8713
Mailing address:
  • Phone: 212-746-2941
  • Fax: 212-746-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number278854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: