Provider Demographics
NPI:1003067570
Name:SAMAROO, DENMATTIE DEVI
Entity Type:Individual
Prefix:MRS
First Name:DENMATTIE
Middle Name:DEVI
Last Name:SAMAROO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 E 220TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5376
Mailing Address - Country:US
Mailing Address - Phone:718-810-6626
Mailing Address - Fax:
Practice Address - Street 1:823 E 220TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5376
Practice Address - Country:US
Practice Address - Phone:718-810-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222445-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse