Individual
GONNA SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5314 CHURCH AVE, BROOKLYN, NY 11203-3609
(718) 240-9031
Mailing address
958 DOWNING RD, VALLEY STREAM, NY 11580-1509
(917) 302-8478
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196832
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11019001500
—
NY
Enumeration date
11/20/2006
Last updated
07/08/2007
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