MEDICARE: AMIR ELSAMADISI 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	2084P0800X	Psychiatry Physician	25MA12123300	NJ

General Provider Information

NPI Number	:	1902488497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR ELSAMADISI MD

Provider Business Mailing Address
First Line	:	1516 NJ-138 SUITE 2A
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719
Country	:	US
Telephone Number	:	848-202-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 NJ-138 SUITE 2A
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719
Country	:	US
Telephone Number	:	848-202-8644
Fax Number	:

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

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	06/23/2026

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