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NPI Code Detail

MEDICARE: SAMUEL PENNELLA MD INC

MEDICARE: SAMUEL PENNELLA MD INC
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1942947965
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMUEL PENNELLA MD INC
Provider Business Mailing Address
First Line : 14 GLENNON FARM LN
Second Line :
City : LEBANON
State : NJ
Zip : 08833-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 GREENFIELD RD STE 300
Second Line :
City : DEARBORN
State : MI
Zip : 48120-1805
Country : US
Telephone Number : 908-208-8926
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. SAMUEL PENNELLA JR.
Credential :
Telephone Number : 908-208-8926
Provider Enumeration Date : 05/20/2022
Last Update Date : 04/07/2026

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