Provider Demographics
NPI:1285910927
Name:SAMUEL EPHRAIM BOOK, MD, FAAD, PLLC
Entity type:Organization
Organization Name:SAMUEL EPHRAIM BOOK, MD, FAAD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:EPHRAIM
Authorized Official - Last Name:BOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-220-2200
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:12553-4746
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:12553-4746
Practice Address - Country:US
Practice Address - Phone:845-220-2200
Practice Address - Fax:845-220-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211008207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH34851Medicare UPIN
NY2K3361Medicare PIN