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General NPI Number Information
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NPI Number | 1760144075
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Entity Type | Individual
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Provider Name | SAMANTHA SOMMER
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 1111 PARK AVE # 1G
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City | NEW YORK
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State | NY
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Zip | 10128-1234
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Country | US
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Telephone | 212-879-8506
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Fax |
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Provider Business Mailing Address
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Address Line | 29 ALTAMORE ST
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City | MELVILLE
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State | NY
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Zip | 11747-2901
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Country | US
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Telephone | 631-912-5392
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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