Healthcare Provider Details

I. General information

NPI: 1073710570
Provider Name (Legal Business Name): SAMANTHA A JAMES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 WESTERN HWY
ORANGEBURG NY
10962-1210
US

IV. Provider business mailing address

1889 WATSON AVE
BRONX NY
10472-5424
US

V. Phone/Fax

Practice location:
  • Phone: 845-848-7709
  • Fax: 845-398-3042
Mailing address:
  • Phone: 914-943-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number000953-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: