MEDICARE: MS. JODI SAMSON

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
1	103K00000X	Behavior Analyst	146824972	NY

General Provider Information

NPI Number	:	1598043465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODI SAMSON

Provider Business Mailing Address
First Line	:	860 9TH AVE APT 2RS
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-4432
Country	:	US
Telephone Number	:	917-804-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 9TH AVE APT 2RS
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-4432
Country	:	US
Telephone Number	:	917-804-3097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/26/2011

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Directions to “ MS. JODI SAMSON ” Practice Location

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