1124075460 NPI number — DR. SHARYAR DANIEL SAMADI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124075460 NPI number — DR. SHARYAR DANIEL SAMADI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMADI
Provider First Name:
SHARYAR
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMADI
Provider Other First Name:
DANIEL
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124075460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 W PLEASANT AVE
Provider Second Line Business Mailing Address:
# 304
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07607-1335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-996-1505
Provider Business Mailing Address Fax Number:
201-996-1605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 FOREST AVE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-996-1505
Provider Business Practice Location Address Fax Number:
201-996-1605
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YP0228X , with the licence number:  25MA07544200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com