Provider Demographics
NPI:1003537747
Name:MERENSKY, SAMANTHA JOAN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOAN
Last Name:MERENSKY
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 1:409 CLAY PITTS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3804
Mailing Address - Country:US
Mailing Address - Phone:516-297-5979
Mailing Address - Fax:
Practice Address - Street 1:409 CLAY PITTS RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3804
Practice Address - Country:US
Practice Address - Phone:516-297-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist