MEDICARE: DR EDUARDO SAMANIEGO - PRIMARY MEDICAL CARE LLC

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	207Q00000X	Family Medicine Physician	25MA08438900	NJ

General Provider Information

NPI Number	:	1255878468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR EDUARDO SAMANIEGO - PRIMARY MEDICAL CARE LLC

Provider Business Mailing Address
First Line	:	945 CRESTWOOD RD
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-4510
Country	:	US
Telephone Number	:	973-333-4480
Fax Number	:	973-900-8809

Provider Business Practice Location Address
First Line	:	76 PROSPECT ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-1881
Country	:	US
Telephone Number	:	973-333-4480
Fax Number	:	973-900-8809

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDUARDO SAMANIEGO
Credential	:	MD
Telephone Number	:	516-775-8605

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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