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NPI Code Detail

MEDICARE: SAMANTHA BLACK

MEDICARE: SAMANTHA BLACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WH0200XHome Health Registered Nurse650105NY

General Provider Information

NPI Number : 1073885315
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BLACK
Provider Business Mailing Address
First Line : 267 44TH ST FL 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-2815
Country : US
Telephone Number : 718-499-6066
Fax Number : 718-499-6065
Provider Business Practice Location Address
First Line : 267 44TH ST FL 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-2815
Country : US
Telephone Number : 718-499-6066
Fax Number : 718-499-6065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 02/02/2012

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Directions to “ SAMANTHA BLACK ” Practice Location

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