Healthcare Provider Details

I. General information

NPI: 1770183790
Provider Name (Legal Business Name): JENNIFER SAMAAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HARRISON AVE
HARRISON NJ
07029-1348
US

IV. Provider business mailing address

11 NATALIE CT
EAST HANOVER NJ
07936-3566
US

V. Phone/Fax

Practice location:
  • Phone: 973-484-2929
  • Fax:
Mailing address:
  • Phone: 201-682-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01065900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26NJ01065900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01065900
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01065900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: