Healthcare Provider Details

I. General information

NPI: 1518445972
Provider Name (Legal Business Name): SAMRA MARKISIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 MYRTLE AVE
GLENDALE NY
11385-7267
US

IV. Provider business mailing address

6 CONISTON CT
WAYNE NJ
07470-2482
US

V. Phone/Fax

Practice location:
  • Phone: 718-873-1444
  • Fax: 718-689-7365
Mailing address:
  • Phone: 917-815-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: