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General NPI Number Information
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NPI Number | 1174787477
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Entity Type | Individual
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Provider Name | STEFAN T SAMUELSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | MOUNT SINAI ROOSEVELT DEPARTMENT OF PAIN MEDICINE 1000 10TH AVE, STE 14A
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City | NEW YORK
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State | NY
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Zip | 10019-1147
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Country | US
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Telephone | 212-594-1600
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Fax |
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Provider Business Mailing Address
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Address Line | MOUNT SINAI ROOSEVELT DEPARTMENT OF PAIN MEDICINE 1000 10TH AVE, STE 14A
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City | NEW YORK
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State | NY
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Zip | 10019-1147
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Country | US
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Telephone | 212-523-6357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 254600
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 254600
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License Number State | NY
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