Healthcare Provider Details

I. General information

NPI: 1174321038
Provider Name (Legal Business Name): SAMANTHA LYNN NEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SUNNY SLOPE RD
BRIDGEWATER NJ
08807-3666
US

IV. Provider business mailing address

3601 SUNNY SLOPE RD
BRIDGEWATER NJ
08807-3666
US

V. Phone/Fax

Practice location:
  • Phone: 856-448-5504
  • Fax:
Mailing address:
  • Phone: 856-448-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00169000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: