Provider Demographics
NPI:1174072102
Name:FLAX, SAMUEL LEON (DPT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LEON
Last Name:FLAX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3026
Mailing Address - Country:US
Mailing Address - Phone:443-220-1988
Mailing Address - Fax:
Practice Address - Street 1:269 W 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6000
Practice Address - Country:US
Practice Address - Phone:646-841-1411
Practice Address - Fax:212-379-2121
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040476-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist