Provider Demographics
NPI:1235335662
Name:GRAY, SAMANTHA (NP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WILLIS AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2125
Mailing Address - Country:US
Mailing Address - Phone:516-484-1333
Mailing Address - Fax:516-621-7158
Practice Address - Street 1:216 WILLIS AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2125
Practice Address - Country:US
Practice Address - Phone:516-484-1333
Practice Address - Fax:516-621-7158
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297896-1163WM0705X, 163WP0809X
NYF302283363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult