Provider Demographics
NPI:1437010220
Name:SEASIDE EAR NOSE AND THROAT MEDICAL
Entity type:Organization
Organization Name:SEASIDE EAR NOSE AND THROAT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUWAA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-363-6877
Mailing Address - Street 1:6818 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5803
Mailing Address - Country:US
Mailing Address - Phone:917-363-6877
Mailing Address - Fax:
Practice Address - Street 1:6818 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5803
Practice Address - Country:US
Practice Address - Phone:917-363-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty