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General NPI Number Information
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NPI Number | 1619265998
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Entity Type | Organization
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Legal Business Name | THE LIGHT MEDICAL, PC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 254 CANAL ST SUITE 5001
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City | NEW YORK
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State | NY
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Zip | 10013-3501
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Country | US
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Telephone | 212-287-3384
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Fax | 212-287-0031
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Provider Business Mailing Address
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Address Line | 15 LEONELLO LANE
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City | STATEN ISLAND
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State | NY
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Zip | 10307-0000
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Country | US
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Telephone | 212-287-3384
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Fax | 212-287-0031
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Authorized Official
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Title or Position | OWNER
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Name | DR. ASHRAF SAMAAN
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Credential | MD
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Telephone | 212-874-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 221203
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License Number State | NY
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