Provider Demographics
NPI:1497427009
Name:BOSTIC, SAMIRAH (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SAMIRAH
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485C US HIGHWAY 1 S STE 100
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3016
Mailing Address - Country:US
Mailing Address - Phone:732-844-3424
Mailing Address - Fax:732-621-8342
Practice Address - Street 1:485C US HIGHWAY 1 S STE 100
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3016
Practice Address - Country:US
Practice Address - Phone:732-844-3424
Practice Address - Fax:732-621-8342
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ011883002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry