Theagene, Samuel Michael

Theagene, Samuel Michael is an individual health care provider with primary practice located at 22422 Merrick Blvd , Laurelton NY 11413-2023. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Theagene, Samuel Michael can be contacted via phone (347) 270-8353.

Contact Information

Primary practice address
22422 Merrick Blvd Laurelton NY 11413-2023
Phone: (347) 270-8353
Fax: (347) 826-1917
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 194218 New York
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 194218 New York

Profile Details

NPI number 1518928167
LBN Legal business name Theagene, Samuel Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Mar 4th, 2024 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518928167 NPPES
New York Other G400043923 PTAN
New York MEDICAID 135761803 PTAN

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