Individual
SAMANTHA IRENE BOGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
31 CHRIS MATT CT, BAY SHORE, NY 11706-6731
(631) 968-9196
Mailing address
31 CHRIS MATT CT, BAY SHORE, NY 11706-6731
(631) 968-9196
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
255708-1
NY
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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