Individual
MRS. MANJU BIJU SAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-1923
(631) 632-6868
Mailing address
4 BERWYN DR, LAKE RONKONKOMA, NY 11779-1923
(631) 525-1801
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F309300-01
NY
Other
Enumeration date
03/08/2020
Last updated
11/23/2021
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