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General NPI Number Information
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NPI Number | 1871057554
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Entity Type | Individual
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Provider Name | DORINDA CONNIE SAMUELS X MD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2019
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Last Update Date | 01/26/2019
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Provider Practice Location Address
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Address Line | 7516 97TH AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-1024
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Country | US
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Telephone | 646-508-3274
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Fax | --
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Provider Business Mailing Address
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Address Line | 910 GREENE AVE
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City | BROOKLYN
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State | NY
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Zip | 11221-2302
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Country | US
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Telephone | 347-792-5794
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 000000000000000
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | X12
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License Number State | NY
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