Provider Demographics
NPI:1235408600
Name:ROSE, SAMANTHA (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1202B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-7788
Mailing Address - Fax:212-876-3255
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-7788
Practice Address - Fax:212-876-3255
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY382258363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics