MEDICARE: SAMANTHA BIERSACK

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	174400000X	Specialist	1362245	NY

General Provider Information

NPI Number	:	1730860313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BIERSACK

Provider Business Mailing Address
First Line	:	3 SHELBY CT
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4946
Country	:	US
Telephone Number	:	516-672-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 SHELBY CT
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4946
Country	:	US
Telephone Number	:	516-672-4622
Fax Number	:

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

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “ SAMANTHA BIERSACK ” Practice Location

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