Provider Demographics
NPI:1396725883
Name:SAMPSON, ERIC L (PT MDT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:PT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2643
Mailing Address - Country:US
Mailing Address - Phone:917-848-0539
Mailing Address - Fax:
Practice Address - Street 1:3923 LAUREL CT
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2643
Practice Address - Country:US
Practice Address - Phone:917-848-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0178742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27Z91Medicare PIN