MEDICARE: SAMUEL ALTSTEIN D.O,

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	210893	NY

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	:	1295793933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL ALTSTEIN D.O,

Provider Business Mailing Address
First Line	:	PO BOX 95000-2454
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-2454
Country	:	US
Telephone Number	:	212-352-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 W 23RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2301
Country	:	US
Telephone Number	:	212-352-2600
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	09/20/2012

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Directions to “ SAMUEL ALTSTEIN D.O,” Practice Location

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