Organization
EAST 29TH ST MEDICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY D SAMUEL MD (OWNER)
(201) 281-8692
Entity
Organization
Contact information
Practice address
542 E 29TH STREET, PATERSON, NJ 07504-1814
(201) 281-8691
Mailing address
716 HUNTINGTON CHASE CT, WARNER ROBINS, GA 31088-2681
(201) 281-8692
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA71838
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8598703
—
NJ
Enumeration date
02/23/2007
Last updated
03/24/2011
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