Healthcare Provider Details

I. General information

NPI: 1285878652
Provider Name (Legal Business Name): SAMUEL GORSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAM GORSTEIN M.D.

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3000
  • Fax:
Mailing address:
  • Phone: 631-376-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250585
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number291986-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number291986-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number250585
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: