Active NPI
Diana Samuel, M.D.
- Psychiatry Physician
- New York, NY
National Provider Identifier
1669791554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 263572
- Practice address
- 1790 Broadway FL 7
New York, NY 10019-1412 - Phone
- (646) 828-7753
- NPI assigned
- May 18, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 263572 | NY | Primary |
Addresses
Primary practice location
1790 Broadway FL 7
New York, NY 10019-1412
Mailing address
1790 Broadway FL 7
New York, NY 10019-1412
Phone (646) 828-7753
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263572 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618444800000",
"number": "1669791554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1790 BROADWAY FL 7",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100191412",
"telephone_number": "646-828-7753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1790 BROADWAY FL 7",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100191412",
"telephone_number": "646-828-7753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "DIANA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-18",
"last_updated": "2021-04-15",
"certification_date": "2021-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "263572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.