Healthcare Provider Details

I. General information

NPI: 1447588694
Provider Name (Legal Business Name): SAMANTHA JEUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA UWHUBETIYI

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 KIRKMAN AVE
ELMONT NY
11003-3737
US

IV. Provider business mailing address

542 KIRKMAN AVE
ELMONT NY
11003-3737
US

V. Phone/Fax

Practice location:
  • Phone: 516-305-4069
  • Fax:
Mailing address:
  • Phone: 516-305-4069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number297605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: