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General NPI Number Information
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NPI Number | 1477686608
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Entity Type | Individual
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Provider Name | M SAMSON SEPLOW D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1423 TILTON RD STE 6
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1857
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Country | US
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Telephone | 609-697-7933
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Fax | 609-772-4850
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Provider Business Mailing Address
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Address Line | 954 CHELTEN HILLS DR
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City | WYNCOTE
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State | PA
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Zip | 19095-1501
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Country | US
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Telephone | 215-885-1647
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS013611
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License Number State | PA
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