Provider Demographics
NPI:1083346662
Name:NAGY, SAMUEL EDWARD
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDWARD
Last Name:NAGY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14963 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-3618
Mailing Address - Country:US
Mailing Address - Phone:952-540-7922
Mailing Address - Fax:
Practice Address - Street 1:18465 ORCHARD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8885
Practice Address - Country:US
Practice Address - Phone:952-428-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer