Provider Demographics
NPI:1215579289
Name:MALONEY, SAMANTHA S (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:S
Last Name:MALONEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 E MAIN ST UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2917
Mailing Address - Country:US
Mailing Address - Phone:631-424-3787
Mailing Address - Fax:
Practice Address - Street 1:241 E MAIN ST UNIT 2C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2917
Practice Address - Country:US
Practice Address - Phone:631-424-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345145207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty