Provider Demographics
NPI:1902925068
Name:DRASSINOWER, SAMUEL BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BORIS
Last Name:DRASSINOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAKE ST # LB1
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3851
Mailing Address - Country:US
Mailing Address - Phone:914-682-0448
Mailing Address - Fax:914-682-0506
Practice Address - Street 1:15 LAKE ST # LB1
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3851
Practice Address - Country:US
Practice Address - Phone:914-682-0448
Practice Address - Fax:914-682-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1055782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0094370OtherGHI
NY42242POtherHIP
NY343541OtherEMPIRE BLUE CROSS
NYWS1173OtherOXFORD
NY154945OtherVALUE OPTIONS
NY00184592Medicaid
NY42242POtherHIP
NY343541OtherEMPIRE BLUE CROSS