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DR. SANJAY SAMUEL MD
NPI 1417180852
General Practice in Brockport, NY

Active since September 02, 2009PECOS Enrolled
156 WEST AVE, BROCKPORT, NY 14420(585) 637-3131(585) 395-6036 Get Directions Write a Review

NPPES record last updated: September 13, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Sanjay Samuel Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SANJAY SAMUEL MD (NPI 1417180852) is an individual general practice provider in Brockport, New York, licensed in New York (254678) and active in the NPI registry since September 2009. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417180852
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameDR. SANJAY SAMUELCredential: MD
Location Address156 WEST AVEBrockport, NY 14420-1229
Mailing Address156 West AveBrockport, NY 14420-1229 · (585) 637-3131
Phone(585) 637-3131
Fax(585) 395-6036
Sole ProprietorNo
Enumeration DateSeptember 2, 2009
Last NPPES UpdateSeptember 13, 2017
✔ NPI 1417180852 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in NY · 254678
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License 254678 (NY)
156 WEST AVE, Brockport, NY 14420
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Sanjay Samuel Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKESIDE IMAGING, LLC
Radiology (Diagnostic Radiology)
156 WEST AVE
BROCKPORT, NY 14420
Monroe County (716) 859-2954
DR. TIMOTHY VERNON HAGY M.D.
Emergency Medicine (Emergency Medical Services)
156 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 395-6095
UNIVERSITY OF ROCHESTER
Pharmacy (Community/Retail Pharmacy)
156 WEST AVE, PHARMACY
BROCKPORT, NY 14420
Monroe County (585) 758-7562
ERIK PETERSON D.O.
Emergency Medicine
156 WEST AVE, EMERGENCY DEPARTMENT
BROCKPORT, NY 14420
Monroe County (585) 395-6095
EMMA LEATHAM PA-C
Physician Assistant (Medical)
156 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 758-7557
AMY LORRAINE STACY MS, RD, CDN
Dietitian, Registered
156 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 395-6095
INTERNAL MEDICINE AT LAKESIDE
Internal Medicine
156 WEST AVE, SUITE 106
BROCKPORT, NY 14420
Monroe County (585) 395-6095
JORDAN BLOCK
Physical Therapist (Orthopedic)
156 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 275-5321

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sanjay Samuel's NPI number?

The NPI number for Sanjay Samuel is 1417180852. It was assigned to this individual provider in the NPPES registry on September 2, 2009.

Where is Sanjay Samuel located?

Sanjay Samuel practices at 156 West Ave, Brockport, NY 14420. The listed phone number is (585) 637-3131.

What is Sanjay Samuel's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Sanjay Samuel enrolled in Medicare?

Yes. Sanjay Samuel is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Sanjay Samuel was last updated on September 13, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.