Individual
DMITRY V SAMSONOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 BRADHURST AVE, STE 1400, HAWTHORNE, NY 10532-2140
(914) 493-7583
(914) 594-4011
Mailing address
PO BOX 1020, HAWTHORNE, NY 10532-7507
(914) 493-7583
(914) 594-4011
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
003556
NY
2080P0210X
Pediatric Nephrology Physician
Primary
269800
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03266039
—
NY
Enumeration date
11/11/2008
Last updated
07/23/2013
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