Healthcare Provider Details

I. General information

NPI: 1295698371
Provider Name (Legal Business Name): SAMANTHA JOACHIM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AMBER LN
OYSTER BAY NY
11771-3115
US

IV. Provider business mailing address

2040 29TH ST
ASTORIA NY
11105-2502
US

V. Phone/Fax

Practice location:
  • Phone: 347-770-4009
  • Fax:
Mailing address:
  • Phone: 908-612-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: