Provider Demographics
NPI:1992899850
Name:THE SAMRA GROUP, LLC
Entity type:Organization
Organization Name:THE SAMRA GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MUNISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-739-2100
Mailing Address - Street 1:300 PERRINE RD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2871
Mailing Address - Country:US
Mailing Address - Phone:732-727-8800
Mailing Address - Fax:732-727-0955
Practice Address - Street 1:300 PERRINE RD
Practice Address - Street 2:SUITE 331
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2871
Practice Address - Country:US
Practice Address - Phone:732-727-8800
Practice Address - Fax:732-727-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0480304Medicaid
NJ0086720Medicaid
NJ0152099Medicaid
NJ0152081Medicaid
NJ3155501Medicaid