Organization
EMPIRE STATE MEDICAL PC
Active
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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