Healthcare Provider Details

I. General information

NPI: 1790604544
Provider Name (Legal Business Name): SAMANTHA STEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 STRAWBERRY LN
STATEN ISLAND NY
10312-6410
US

IV. Provider business mailing address

9 STRAWBERRY LN
STATEN ISLAND NY
10312-6410
US

V. Phone/Fax

Practice location:
  • Phone: 718-702-6732
  • Fax: 999-999-9999
Mailing address:
  • Phone: 718-702-6732
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: