Provider Demographics
NPI:1477711141
Name:ASAMOAH, SAMUEL MANUENA (RN)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:MANUENA
Last Name:ASAMOAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:ASAMOAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-841-5157
Mailing Address - Fax:
Practice Address - Street 1:68 HEUPPAUGE RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-715-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5904101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse