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General NPI Number Information
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NPI Number | 1124837042
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Entity Type | Individual
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Provider Name | GRACE SAMUEL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 26901 76TH AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1433
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Country | US
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Telephone | 718-470-7380
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Fax |
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Provider Business Mailing Address
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Address Line | 171 KILBURN RD S
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City | GARDEN CITY SOUTH
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State | NY
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Zip | 11530-5628
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F353468
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License Number State | NY
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