Healthcare Provider Details

I. General information

NPI: 1952838294
Provider Name (Legal Business Name): SAMANTHA NEWSTADT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7307
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-8080
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC006845
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: