Provider Demographics
NPI:1174528137
Name:SAMSON, JOSEPHINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4964
Mailing Address - Country:US
Mailing Address - Phone:212-396-9411
Mailing Address - Fax:212-396-0345
Practice Address - Street 1:14 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4964
Practice Address - Country:US
Practice Address - Phone:212-396-9411
Practice Address - Fax:212-396-0345
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204647207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG81304Medicare UPIN
NY2U0571Medicare ID - Type Unspecified