Healthcare Provider Details

I. General information

NPI: 1871114108
Provider Name (Legal Business Name): SAMANTHA DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

11 ACORN AVE
FARMINGVILLE NY
11738-1704
US

V. Phone/Fax

Practice location:
  • Phone: 866-322-7691
  • Fax: 866-322-7691
Mailing address:
  • Phone: 516-491-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN007286-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007286-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN007286-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: