Provider Demographics
NPI:1508804824
Name:SAMUELS, MICHELLE KAREN II (NP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:KAREN
Last Name:SAMUELS
Suffix:II
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121A WEST 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2653
Mailing Address - Country:US
Mailing Address - Phone:212-337-5665
Mailing Address - Fax:212-337-5622
Practice Address - Street 1:121A WEST 20TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2653
Practice Address - Country:US
Practice Address - Phone:212-337-5665
Practice Address - Fax:212-337-5622
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304192363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03293327Medicaid
NYA400037605OtherMEDICARE