MEDICARE: JUSTIN TODD SAMBOL 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MA068900	NJ

General Provider Information

NPI Number	:	1376523266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TODD SAMBOL MD

Provider Business Mailing Address
First Line	:	PO BOX 18925
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07191-8925
Country	:	US
Telephone Number	:	973-972-3555
Fax Number	:	972-972-3510

Provider Business Practice Location Address
First Line	:	150 BERGEN ST
Second Line	:	F 102
City	:	NEWARK
State	:	NJ
Zip	:	07103-2496
Country	:	US
Telephone Number	:	973-972-3555
Fax Number	:	973-972-3510

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	01/25/2022

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