=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992401079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA SAMADI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2023
-----------------------------------------------------
Last Update Date | 02/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 W BRIGHTON AVE STE 103
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11224-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-996-2260
-----------------------------------------------------
Fax | 718-996-1123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 COLUMBIA AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-836-0664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 351227
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------