Healthcare Provider Details

I. General information

NPI: 1851204473
Provider Name (Legal Business Name): SAMANTHA M THEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EAST SUNRISE HIGHWAY
LINDENHURST NY
11757
US

IV. Provider business mailing address

550 BELLMORE AVE
EAST MEADOW NY
11554-4710
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5544
  • Fax:
Mailing address:
  • Phone: 516-554-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: