Individual
MISS SAMANTHA ANN BASILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 SHIELDS AVE, WILLISTON PARK, NY 11596-2316
(516) 236-9018
Mailing address
100 SHIELDS AVE, WILLISTON PARK, NY 11596-2316
(516) 236-9018
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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