Provider Demographics
NPI:1417199050
Name:HERMAN, SAMANTHA PAIGE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2211
Mailing Address - Country:US
Mailing Address - Phone:201-867-8550
Mailing Address - Fax:201-861-2223
Practice Address - Street 1:411 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2211
Practice Address - Country:US
Practice Address - Phone:201-867-8550
Practice Address - Fax:201-861-2223
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09321900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty