Provider Demographics
NPI:1962233791
Name:MEDICAL SERVICES OF STATEN ISLAND PLLC
Entity type:Organization
Organization Name:MEDICAL SERVICES OF STATEN ISLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-227-1282
Mailing Address - Street 1:10 WHITE ROCK TER
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1645
Mailing Address - Country:US
Mailing Address - Phone:718-227-1282
Mailing Address - Fax:
Practice Address - Street 1:4277 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2021
Practice Address - Country:US
Practice Address - Phone:718-227-1282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty