Individual
JANE SAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
123 GENESEE ST, NEW HARTFORD, NY 13413-2323
(315) 797-2314
(315) 797-0850
Mailing address
123 GENESEE ST, NEW HARTFORD, NY 13413-2323
(315) 797-2314
(315) 797-0850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
221758
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02200806
—
NY
01
—
040426014483
FIDELIS MEDICAID
NY
01
—
085594
MVP
NY
01
—
10068900
CDPHP
NY
01
—
2122373
UHC
NY
01
—
34571
RAILROAD MEDICARE
NY
01
—
7234284
AETNA
NY
Enumeration date
09/12/2006
Last updated
07/08/2007
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