Samudio, Javier A
Samudio, Javier A is an sole proprietor health care provider with primary practice located at 1847 Mott Ave Fl 2 , Far Rockaway NY 11691-4201. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Samudio, Javier A can be contacted via phone (718) 327-7000.Contact Information
Primary practice address
1847 Mott Ave Fl 2
Far Rockaway NY 11691-4201
Phone: (718) 327-7000
Fax: (718) 471-2071
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 044530 | New York |
Profile Details
| NPI number | 1679534895 |
|---|---|
| LBN Legal business name | Samudio, Javier A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 29th, 2006 |
| Last updated | Oct 2nd, 2012 - about 12 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 | 1679534895 | NPPES |
| New York | MEDICAID | 01400191 |
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