Healthcare Provider Details

I. General information

NPI: 1467880989
Provider Name (Legal Business Name): SAMUEL A AGAHIU MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALAN RD
SPRING VALLEY NY
10977-6047
US

IV. Provider business mailing address

PO BOX 233
SPRING VALLEY NY
10977-0233
US

V. Phone/Fax

Practice location:
  • Phone: 518-248-2102
  • Fax:
Mailing address:
  • Phone: 518-248-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number249859
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SAMUEL AMINU AGAHIU
Title or Position: NEPHROLOGIST
Credential: MD
Phone: 518-248-2102