Organization
EMPIRE STATE MEDICAL PC
Active
Other names
SAMUEL THEAGENE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL THEAGENE M.D. (OWNER)
(347) 270-8353
Entity
Organization
Contact information
Practice address
10649 SUTPHIN BLVD, JAMAICA, NY 11435-5135
(929) 393-1966
(929) 755-4044
Mailing address
PO BOX 120328, SAINT ALBANS, NY 11412-0328
(347) 270-8353
(347) 826-1917
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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