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NPI Code Detail

MEDICARE: SAMANTHA POULIS

MEDICARE:   SAMANTHA  POULIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse622141NY

General Provider Information

NPI Number : 1083943401
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA POULIS
Provider Business Mailing Address
First Line : 150 HAWTHORNE ST
Second Line : APT 5P
City : BROOKLYN
State : NY
Zip : 11225-5859
Country : US
Telephone Number : 718-940-1537
Fax Number :
Provider Business Practice Location Address
First Line : 150 HAWTHORNE ST
Second Line : APT 5P
City : BROOKLYN
State : NY
Zip : 11225-5859
Country : US
Telephone Number : 718-940-1537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2009
Last Update Date : 12/14/2009

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Directions to “ SAMANTHA POULIS ” Practice Location

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