Provider Demographics
NPI:1235398959
Name:SAMUELS, JOAN C (PA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:C
Last Name:SAMUELS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:STONYBROOK MEDICAL CENTER
Mailing Address - Street 2:EMPLOYEE HEALTH SERVICE
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7409
Mailing Address - Country:US
Mailing Address - Phone:631-444-7767
Mailing Address - Fax:631-444-6199
Practice Address - Street 1:STONY BROOK MEDICAL CTR
Practice Address - Street 2:EMPLOYEE HEALTH SERVICE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7409
Practice Address - Country:US
Practice Address - Phone:631-444-7767
Practice Address - Fax:631-444-6199
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
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Provider Licenses
StateLicense IDTaxonomies
NY3246-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant