East 29TH St Medical Associates, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MA71838 Issued in NJ

Legal business name

EAST 29TH ST MEDICAL ASSOCIATES, P.C.

Practice address

542 E 29TH Street
Paterson, NJ 07504-1814

Phone

(201) 281-8691

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Shelly D Samuel, MD

Title

Owner

Phone

(201) 281-8692

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1740315225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 HUNTINGTON CHASE CT",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310882681",
            "telephone_number": "201-281-8692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 E 29TH STREET",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041814",
            "telephone_number": "201-281-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST 29TH ST MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-281-8692",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA71838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8598703",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; 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.