Healthcare Provider Details

I. General information

NPI: 1265670426
Provider Name (Legal Business Name): SAMANTHA ANN JANISZEWSKI R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ANN JANISZEWSKI R.T.

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 CHANNEL CT
NEWARK DE
19702-4827
US

IV. Provider business mailing address

609 CHANNEL CT
NEWARK DE
19702-4827
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-8389
  • Fax:
Mailing address:
  • Phone: 302-838-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: