MEDICARE: DR. SAMUEL A BANIGO M.D.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	25MA07986300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063503555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL A BANIGO M.D.,

Provider Business Mailing Address
First Line	:	105 INDEPENDENCE DR
Second Line	:
City	:	ROSELLE
State	:	NJ
Zip	:	07203-2410
Country	:	US
Telephone Number	:	908-245-3637
Fax Number	:	973-375-5766

Provider Business Practice Location Address
First Line	:	40 UNION AVE
Second Line	:	STE.204
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3277
Country	:	US
Telephone Number	:	973-416-6981
Fax Number	:	973-375-5766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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