Provider Demographics
NPI:1336355403
Name:SOSTRE, SAMUEL SEBASTIANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SEBASTIANNE
Last Name:SOSTRE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:530 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3654
Mailing Address - Country:US
Mailing Address - Phone:732-324-5138
Mailing Address - Fax:732-324-5139
Practice Address - Street 1:80TH ST & 41ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3900
Practice Address - Fax:718-334-5958
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-10-22
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Provider Licenses
StateLicense IDTaxonomies
NY2279742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid