MEDICARE: NEIL SAMUELS

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	222Q00000X	Developmental Therapist	00253046	NJ

General Provider Information

NPI Number	:	1306728001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL SAMUELS

Provider Business Mailing Address
First Line	:	2157 CENTER AVE APT 24
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5852
Country	:	US
Telephone Number	:	201-741-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2157 CENTER AVE APT 24
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5852
Country	:	US
Telephone Number	:	201-741-9203
Fax Number	:

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

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/23/2025

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Directions to “ NEIL SAMUELS ” Practice Location

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