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General NPI Number Information
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NPI Number | 1407242738
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Entity Type | Individual
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Provider Name | SAMANTHA KAOUTARANI NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 491 VAN ORDEN ST
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5236
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Country | US
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Telephone | 201-450-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 491 VAN ORDEN ST
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5236
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Country | US
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Telephone | 201-450-2530
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15204700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86019481
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License Number State | NJ
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