Healthcare Provider Details

I. General information

NPI: 1043472004
Provider Name (Legal Business Name): SAMANTHA HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA OSUNSANMI

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAVEN AVE APT 5J
NEW YORK NY
10033-5307
US

IV. Provider business mailing address

500 W MAIN ST
WYCKOFF NJ
07481-1439
US

V. Phone/Fax

Practice location:
  • Phone: 347-385-8944
  • Fax:
Mailing address:
  • Phone: 201-847-9403
  • Fax: 201-847-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA089398
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: