Individual provider Active NPI

Samuel Wahl, MD

  • Anatomic Pathology Physician
  • New York, NY
National Provider Identifier
1710959093
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
179952 Issued in NY
Practice address
100 E 77TH St
Suite 12
New York, NY 10021-1850
Phone
(212) 434-2361
Fax
(212) 434-4512
NPI assigned
Feb 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 179952 NY Primary

Addresses

Primary practice location

100 E 77TH St
Suite 12
New York, NY 10021-1850

Mailing address

100 E 77TH St
Suite 12
New York, NY 10021-1850
Phone (212) 434-2361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061226000093 NY Practitioner - Pathology 1254331234 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Side Medical PCGroup PAC ID 6002985256, 5 clinicians
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

132 E 76TH St
Ofc 2G
New York, NY 10021-2850
Phone (212) 794-0833

221 Jericho Tpke
Syosset, NY 11791-4515
Phone (516) 496-2752

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
179952NYMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Feb 1, 2014 Accepting new patients
North Shore - Lij Medical PC CurrentSince Feb 1, 2014 Accepting new patients
East Side Medical, P.C. CurrentSince Dec 14, 2022 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

1554 Northern Blvd
Manhasset, NY 11030
Phone (516) 390-9242

26901 76th Ave
New Hyde Park, NY 11040
Phone (718) 470-3000

100 E 77th St
Ste 12
New York, NY 10075
Phone (212) 434-2361

132 E 76th St
Ofc 2G
New York, NY 10021
Phone (212) 794-0833

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

221 Jericho Tpke
Syosset, NY 11791
Phone (516) 496-6400

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1710959093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "address_2": "SUITE 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100211850",
            "telephone_number": "212-434-2361",
            "fax_number": "212-434-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "address_2": "SUITE 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100211850",
            "telephone_number": "212-434-2361",
            "fax_number": "212-434-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "SAMUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NY",
            "license": "179952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.