Healthcare Provider Details

I. General information

NPI: 1891233623
Provider Name (Legal Business Name): SAMANTHA MARIE VROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SKYLINE DR
STATEN ISLAND NY
10304-4832
US

IV. Provider business mailing address

328 S RAILROAD ST
STATEN ISLAND NY
10312-4060
US

V. Phone/Fax

Practice location:
  • Phone: 718-727-8202
  • Fax:
Mailing address:
  • Phone:
  • 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: