Healthcare Provider Details

I. General information

NPI: 1073209433
Provider Name (Legal Business Name): ABDUL SAMI AHMED DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HDSN VLY PROF PLZ STE B
NEWBURGH NY
12550-3157
US

IV. Provider business mailing address

4 HDSN VLY PROF PLZ STE B
NEWBURGH NY
12550-3157
US

V. Phone/Fax

Practice location:
  • Phone: 877-374-2362
  • Fax:
Mailing address:
  • Phone: 877-374-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN007510-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: