Healthcare Provider Details

I. General information

NPI: 1811547763
Provider Name (Legal Business Name): SAMANTHA BOGAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA CHESNEY R.N.

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 4TH AVE
BROOKLYN NY
11209-3439
US

IV. Provider business mailing address

92 HOPKINS AVE
STATEN ISLAND NY
10306-3827
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-2399
  • Fax: 718-836-2305
Mailing address:
  • Phone: 917-780-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: