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General NPI Number Information
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NPI Number | 1578500955
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Entity Type | Individual
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Provider Name | SAMSON G VIMALANANDA MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 1610 ROUTE 88 FL 3
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City | BRICK
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State | NJ
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Zip | 08724-3018
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Country | US
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Telephone | 732-295-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 120 SISTER PIERRE DR SUITE 403
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City | TOWSON
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State | MA
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Zip | 21204
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Country | US
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Telephone | 410-827-6408
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Fax | 443-279-0537
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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 | D20273
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 25MA10657200
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License Number State | NJ
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