Healthcare Provider Details

I. General information

NPI: 1619887932
Provider Name (Legal Business Name): SAMANTHA PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1465 PARK AVE APT 806
NEW YORK NY
10029-4096
US

IV. Provider business mailing address

1465 PARK AVE APT 806
NEW YORK NY
10029-4096
US

V. Phone/Fax

Practice location:
  • Phone: 646-570-8856
  • Fax: 646-570-8856
Mailing address:
  • Phone: 646-570-8856
  • Fax: 646-570-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number22652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: