Provider Demographics
NPI:1063712834
Name:SAMARA SPRING CHURGIN MEDICAL DOCTOR PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SAMARA SPRING CHURGIN MEDICAL DOCTOR PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:SPRING
Authorized Official - Last Name:CHURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-661-0202
Mailing Address - Street 1:661 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1300
Mailing Address - Country:US
Mailing Address - Phone:631-661-0202
Mailing Address - Fax:631-661-0559
Practice Address - Street 1:661 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1300
Practice Address - Country:US
Practice Address - Phone:631-661-0202
Practice Address - Fax:631-661-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2408892086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty