Healthcare Provider Details

I. General information

NPI: 1568755460
Provider Name (Legal Business Name): SAMEH ELGUIZAOUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

159 E 74TH ST FL 2
NEW YORK NY
10021-3309
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax: 212-734-0407
Mailing address:
  • Phone: 212-737-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number283141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: