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General NPI Number Information
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NPI Number | 1033058326
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Entity Type | Individual
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Provider Name | SAMANTHA DIANE ANDERER PA-C, MS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 2374 JERUSALEM AVE
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-1825
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Country | US
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Telephone | 516-409-8311
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CARRIAGE DR
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City | KINGS PARK
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State | NY
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Zip | 11754-2809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 035626
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License Number State | NY
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