Healthcare Provider Details

I. General information

NPI: 1730308925
Provider Name (Legal Business Name): SAMARITAN PEDIATRIC SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

IV. Provider business mailing address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-2100
  • Fax: 631-321-2246
Mailing address:
  • Phone: 631-321-2100
  • Fax: 631-321-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CATHERINE CARONIA
Title or Position: DIRECTOR OF GROUP
Credential: MD
Phone: 631-376-4003