Healthcare Provider Details

I. General information

NPI: 1871930792
Provider Name (Legal Business Name): SAMANTHA N MUSOLINO F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 59 SUITE 101
SUFFERN NY
10901-4927
US

IV. Provider business mailing address

20 GRAND STREET, 3RD FL
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-2172
  • Fax:
Mailing address:
  • Phone: 845-987-3906
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number646340
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340318-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: