Healthcare Provider Details

I. General information

NPI: 1194445437
Provider Name (Legal Business Name): SAMANTHA CAREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROADHOLLOW RD STE 200
MELVILLE NY
11747-4833
US

IV. Provider business mailing address

56 CHAMPLIN ST
RONKONKOMA NY
11779-1833
US

V. Phone/Fax

Practice location:
  • Phone: 631-592-5018
  • Fax:
Mailing address:
  • Phone: 631-827-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number812540
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: