Healthcare Provider Details

I. General information

NPI: 1881279180
Provider Name (Legal Business Name): SAMANTHA CHAM CPCP. CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 55TH ST APT 107
NEW YORK NY
10022-4148
US

IV. Provider business mailing address

305 E 55TH ST APT 107
NEW YORK NY
10022-4148
US

V. Phone/Fax

Practice location:
  • Phone: 347-803-5255
  • Fax:
Mailing address:
  • Phone: 347-803-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number50081342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: