Provider Demographics
NPI:1861410870
Name:SAMUEL, STEVEN K (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 OLD COUNTRY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2121
Mailing Address - Country:US
Mailing Address - Phone:516-351-2213
Mailing Address - Fax:888-202-2608
Practice Address - Street 1:1919 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1710
Practice Address - Country:US
Practice Address - Phone:516-227-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238889-1208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801605Medicaid
P00334123OtherRAILROAD
NY2587Q1OtherBCBS
NY2647Q1Medicare PIN
NY2587Q1OtherBCBS