Individual
IMMACULA SAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-3226
Mailing address
46 ASHLEY DR, VALLEY STREAM, NY 11580-2439
(516) 943-3952
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
9854779
NY
Other
Enumeration date
04/17/2018
Last updated
06/16/2018
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