Sample, Jason M
Sample, Jason M is an individual health care provider with primary practice located at 56-45 Main Street W-Ll300, Flushing NY 11355-5045. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Sample, Jason M can be contacted via phone (718) 445-0220.Contact Information
Primary practice address
56-45 Main Street W-Ll300
Flushing NY 11355-5045
Phone: (718) 445-0220
Fax: (718) 939-1167
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 215514 | New York |
Profile Details
| NPI number | 1912968298 |
|---|---|
| LBN Legal business name | Sample, Jason M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2006 |
| Last updated | Oct 22nd, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912968298 | NPPES |
| New York | MEDICAID | 02427085 |
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