Healthcare Provider Details

I. General information

NPI: 1730919861
Provider Name (Legal Business Name): SAMANTHA HARWOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COMMACK RD STE 201
COMMACK NY
11725-5020
US

IV. Provider business mailing address

49 MEREDITH LN
OAKDALE NY
11769-1007
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2599
  • Fax:
Mailing address:
  • Phone: 631-241-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354619-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: