Provider Demographics
NPI:1174594816
Name:MAYERFIELD, SAMUEL M (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:MAYERFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:445 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-687-6054
Mailing Address - Fax:908-686-7099
Practice Address - Street 1:3 CORWIN CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5107
Practice Address - Country:US
Practice Address - Phone:845-561-1551
Practice Address - Fax:845-561-3269
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY147116-12085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01098879Medicaid
NY01098879Medicaid
NY46E271Medicare PIN