Healthcare Provider Details

I. General information

NPI: 1609294651
Provider Name (Legal Business Name): SAMUEL SON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE N511
RYE BROOK NY
10573-1387
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4900
  • Fax: 248-601-4994
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number294508-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: