Individual provider Active NPI

Mark Samuel

  • Non-emergency Medical Transport (VAN)
  • Uniondale, NY
National Provider Identifier
1487139002
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-emergency Medical Transport (VAN)Taxonomy code 343900000X
Practice address
750 Park Ave
Uniondale, NY 11553-3225
Phone
(516) 303-2443
NPI assigned
Sep 28, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-emergency Medical Transport (VAN) 343900000X Primary

Addresses

Primary practice location

750 Park Ave
Uniondale, NY 11553-3225

Mailing address

750 Park Ave
Uniondale, NY 11553-3225
Phone (516) 303-2443

Other identifiers 1

IdentifierTypeStateIssuer
616636652MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1487139002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 PARK AVE",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115533225",
            "telephone_number": "516-303-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 PARK AVE",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115533225",
            "telephone_number": "516-303-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "616636652",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Uniondale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.