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General NPI Number Information
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NPI Number | 1710078787
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Entity Type | Individual
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Provider Name | DR. JACOB A SAMANDER
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 165 MAIN ST
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City | OSSINING
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State | NY
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Zip | 10562-4702
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Country | US
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Telephone | 914-941-1263
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Fax |
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Provider Business Mailing Address
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Address Line | 5265 UNIVERSITY PKWY UNIT 101
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City | UNIVERSITY PARK
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State | FL
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Zip | 34201-3012
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Country | US
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Telephone | 914-941-1263
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME63339
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 44382
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 241562-01
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License Number State | NY
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