Healthcare Provider Details

I. General information

NPI: 1265927404
Provider Name (Legal Business Name): SAMANTHA GREALY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

IV. Provider business mailing address

120 E 86TH ST
NEW YORK NY
10028-1062
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1584
  • Fax:
Mailing address:
  • Phone: 203-520-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number343083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: