Healthcare Provider Details

I. General information

NPI: 1710209655
Provider Name (Legal Business Name): AIAD L. SAMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CENTER PL
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

47 CENTER PL
STATEN ISLAND NY
10306-5711
US

V. Phone/Fax

Practice location:
  • Phone: 718-285-1469
  • Fax:
Mailing address:
  • Phone: 718-285-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040789-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: