Provider Demographics
NPI:1437116076
Name:SAMPAT, ANU (MD)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:SAMPAT
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 1:10 WHITE ROCK TER
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1645
Mailing Address - Country:US
Mailing Address - Phone:732-888-1030
Mailing Address - Fax:
Practice Address - Street 1:305 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3730
Practice Address - Country:US
Practice Address - Phone:718-876-9600
Practice Address - Fax:718-876-7773
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201639207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS5401738OtherDEA
24N771Medicare ID - Type Unspecified
G51331Medicare UPIN