MEDICARE: MS. FOTA SAMAKAI NP

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
1	363LF0000X	Family Nurse Practitioner	F338247-1	NY

General Provider Information

NPI Number	:	1073928529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FOTA SAMAKAI NP

Provider Business Mailing Address
First Line	:	1000 TENTH AVE
Second Line	:	MOUNT SINAI-ROOSEVELT HOSPITAL
City	:	NEW YORK
State	:	NY
Zip	:	10019
Country	:	US
Telephone Number	:	212-523-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 NETHERLAND AVE APT 1901
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4819
Country	:	US
Telephone Number	:	917-865-2519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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