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General NPI Number Information
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NPI Number | 1689084923
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Entity Type | Individual
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Provider Name | SAMANTHA BICKERTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 94 OLD SHORT HILLS RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-322-8945
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Fax | 973-322-2471
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Provider Business Mailing Address
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Address Line | 94 OLD SHORT HILLS RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-322-8945
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Fax | 973-322-2471
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00332300
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License Number State | NJ
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