Healthcare Provider Details

I. General information

NPI: 1508363367
Provider Name (Legal Business Name): SAMANTHA LYNN RUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 OLD ROUTE 9W STE 200
NEW WINDSOR NY
12553-5485
US

IV. Provider business mailing address

92 OLD ROUTE 9W STE 200
NEW WINDSOR NY
12553-5485
US

V. Phone/Fax

Practice location:
  • Phone: 845-549-1010
  • Fax: 845-565-5027
Mailing address:
  • Phone: 845-549-1010
  • Fax: 845-565-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number324555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: