MEDICARE: MR. ANGELO PUNO SAMANO

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	225200000X	Physical Therapy Assistant	012689	NY
2	225100000X	Physical Therapist	047095	NY

General Provider Information

NPI Number	:	1902769623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANGELO PUNO SAMANO

Provider Business Mailing Address
First Line	:	198-12 HILLSIDE AVENUE
Second Line	:	APT 2R
City	:	HOLLIS
State	:	NY
Zip	:	11423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	198-12 HILLSIDE AVENUE
Second Line	:	APT 2R
City	:	HOLLIS
State	:	NY
Zip	:	11423
Country	:	US
Telephone Number	:	914-473-0463
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ MR. ANGELO PUNO SAMANO ” Practice Location

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