Provider Demographics
NPI:1316187594
Name:SAMONTE, SAM LAGGUI JR (APN)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:LAGGUI
Last Name:SAMONTE
Suffix:JR
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:LAGGUI
Other - Last Name:SAMONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:73 WILLARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:201-486-9310
Mailing Address - Fax:
Practice Address - Street 1:275 HOBART ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3396
Practice Address - Country:US
Practice Address - Phone:732-376-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00187100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health