Individual
MRS. SAMANTHA BOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1601 3RD AVE, NEW YORK, NY 10128-3416
(516) 622-6000
Mailing address
92 HOPKINS AVE, STATEN ISLAND, NY 10306-3827
(917) 780-6910
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
383031
NY
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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