Provider Demographics
NPI:1194806356
Name:SAMUEL UDELL
Entity type:Organization
Organization Name:SAMUEL UDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-662-8999
Mailing Address - Street 1:5635 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1853
Mailing Address - Country:US
Mailing Address - Phone:856-662-8999
Mailing Address - Fax:856-662-8855
Practice Address - Street 1:5635 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1853
Practice Address - Country:US
Practice Address - Phone:856-662-8999
Practice Address - Fax:856-662-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00157100332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies