Provider Demographics
NPI:1699154039
Name:SAMUEL J. STEIN M.D.
Entity type:Organization
Organization Name:SAMUEL J. STEIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-338-0165
Mailing Address - Street 1:51 HURLEY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3747
Mailing Address - Country:US
Mailing Address - Phone:845-338-0165
Mailing Address - Fax:845-338-0619
Practice Address - Street 1:51 HURLEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3747
Practice Address - Country:US
Practice Address - Phone:845-338-0165
Practice Address - Fax:845-338-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI4198515OtherAETNA IDENTIFICATION NUMBER
NYP00814179OtherRAILROAD MEDICARE PTAN
NY0481714OtherUNITED HEALTH CARE IDENTIFICATION NUMBER
NY0041812OtherGHI IDENTIFICATION NUMBER
NY10023501OtherCDPHP IDENTIFICATION NUMBER
NY00525879Medicaid
NY103235OtherGHI HMO IDENTIFICATION NUMBER
NY103235OtherWELLCARE IDENTIFICATION NUMBER
NY153461OtherBLUE CROSS/BLUE SHIELD IDENTIFICATION NUMBER
NY00525879Medicaid