Provider Demographics
NPI:1154573665
Name:BURSHEH, SAMAR SAMIR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:SAMIR
Last Name:BURSHEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 VENTNOR AVE
Mailing Address - Street 2:STE C
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2166
Mailing Address - Country:US
Mailing Address - Phone:609-350-6780
Mailing Address - Fax:609-350-6995
Practice Address - Street 1:6725 VENTNOR AVE
Practice Address - Street 2:STE C
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2166
Practice Address - Country:US
Practice Address - Phone:609-350-6780
Practice Address - Fax:609-350-6995
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08952900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist