Provider Demographics
NPI:1558621540
Name:TORREGROSSA, SAMANTHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:TORREGROSSA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LOUIS KOSSUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1514
Mailing Address - Country:US
Mailing Address - Phone:631-387-1516
Mailing Address - Fax:
Practice Address - Street 1:1650 LOUIS KOSSUTH AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1514
Practice Address - Country:US
Practice Address - Phone:631-387-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306182-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse