Individual
JASON M SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
56-45 MAIN STREET, W-LL300, FLUSHING, NY 11355-5045
(718) 445-0220
(718) 939-1167
Mailing address
56-45 MAIN STREET, W-LL300, FLUSHING, NY 11355-5045
(718) 445-0220
(718) 939-1167
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
215514
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02427085
—
NY
Enumeration date
03/28/2006
Last updated
09/26/2024
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