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NPI Code Detail

MEDICARE: DR. SAMUEL FENNER MD

MEDICARE: DR. SAMUEL FENNER MD
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
1207L00000XAnesthesiology Physician179593NY

Other Identifiers

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

General Provider Information

NPI Number : 1073519799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL FENNER MD
Provider Business Mailing Address
First Line : PO BOX 28082
Second Line :
City : NEW YORK
State : NY
Zip : 10087-8082
Country : US
Telephone Number : 212-987-3100
Fax Number :
Provider Business Practice Location Address
First Line : 1000 10TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10019-1147
Country : US
Telephone Number : 212-987-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 08/20/2025

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