Healthcare Provider Details

I. General information

NPI: 1790593234
Provider Name (Legal Business Name): SAMANTHA JEAN MASETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PARAGON WAY STE 300
FREEHOLD NJ
07728-7805
US

IV. Provider business mailing address

6 E FRANCESA CT
FARMINGDALE NJ
07727-4305
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-9800
  • Fax:
Mailing address:
  • Phone: 516-582-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355171
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15225700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: