Healthcare Provider Details

I. General information

NPI: 1134055528
Provider Name (Legal Business Name): SAMANTHA ARDEN SOREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

1755 HEATHER LN
HIGHLAND PARK IL
60035-3717
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8288
  • Fax:
Mailing address:
  • Phone: 847-778-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312761-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: