Provider Demographics
NPI:1538145768
Name:SAMAROO, DENISE J (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:J
Last Name:SAMAROO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4208
Mailing Address - Country:US
Mailing Address - Phone:914-939-0982
Mailing Address - Fax:914-939-1041
Practice Address - Street 1:15 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-939-0982
Practice Address - Fax:914-939-1041
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU57438Medicare UPIN
NYC58171Medicare PIN