Healthcare Provider Details

I. General information

NPI: 1306385547
Provider Name (Legal Business Name): SAMANTHA ROSNER AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

127 CHATHAM DR
OAKDALE NY
11769-1403
US

V. Phone/Fax

Practice location:
  • Phone: 631-275-7674
  • Fax:
Mailing address:
  • Phone: 631-275-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307982-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: