Provider Demographics
NPI:1063419810
Name:DUNCAN, SAMUEL T (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 MARION ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4118
Mailing Address - Country:US
Mailing Address - Phone:973-762-4996
Mailing Address - Fax:908-688-8829
Practice Address - Street 1:2040 MILLBURN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3726
Practice Address - Country:US
Practice Address - Phone:973-762-4996
Practice Address - Fax:973-762-4955
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51424207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5654602Medicaid
001922Medicare PIN
NJ5654602Medicaid