Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 25MA07567400 | NJ |
NPI | 1396770426 |
---|---|
Provider Name | Sammy I Masri |
First Address | Paramus, NJ 07652-1433 |
Second Address | Paramus, NJ 07652-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82983 | (02) | NJ |