Provider Demographics
NPI:1396634754
Name:MASTROCOLA, SAMANTHA LYNN (PA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:MASTROCOLA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:35 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2549
Mailing Address - Country:US
Mailing Address - Phone:201-588-3491
Mailing Address - Fax:
Practice Address - Street 1:171 RIDGEDALE AVE STE N
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:201-588-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant