Provider Demographics
NPI:1710044169
Name:SAMALA, GEORGE SIMINIG (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:SIMINIG
Last Name:SAMALA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CHARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1011
Mailing Address - Country:US
Mailing Address - Phone:914-450-3850
Mailing Address - Fax:
Practice Address - Street 1:755 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3458
Practice Address - Country:US
Practice Address - Phone:914-450-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017906-1225100000X
NJ40QA007667002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082640XBWMedicare UPIN