Healthcare Provider Details

I. General information

NPI: 1508216656
Provider Name (Legal Business Name): SAMANTHA MARINARO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 CROSSWAYS PARK DR
WOODBURY NY
11797-2066
US

IV. Provider business mailing address

321 CROSSWAYS PARK DR
WOODBURY NY
11797-2066
US

V. Phone/Fax

Practice location:
  • Phone: 516-992-5219
  • Fax:
Mailing address:
  • Phone: 516-992-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number700927-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number346510
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: