Provider Demographics
NPI:1215928619
Name:BOOK, SAMUEL E (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:BOOK
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 1:575 HUDSON VALLEY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4747
Mailing Address - Country:US
Mailing Address - Phone:845-220-2200
Mailing Address - Fax:845-220-2249
Practice Address - Street 1:575 HUDSON VALLEY AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4747
Practice Address - Country:US
Practice Address - Phone:845-220-2200
Practice Address - Fax:845-220-2249
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040087207N00000X
NY211008207NS0135X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34851Medicare UPIN
NY2K3361Medicare ID - Type Unspecified