=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598819971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN GEORGE SAMANICH MD, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 03/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HUNTER AVE STE A
-----------------------------------------------------
City | ARMONK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10504-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-236-0336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 SADDLE RIDGE RD
-----------------------------------------------------
City | POUND RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10576-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-279-9324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 225961
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------