Individual
MR. SAMSON ITIETIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
506 MALCOLM X BLVD, NEW YORK, NY 10037-1802
(212) 939-3550
Mailing address
1154 ROSSE AVE, NEW MILFORD, NJ 07646-3230
(201) 530-1686
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
435325-1
NY
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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