Provider Demographics
NPI:1659396059
Name:BEIL, SAMANTHA ANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANNE
Last Name:BEIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:ANNE
Other - Last Name:LOPALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:6277 JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-462-6644
Mailing Address - Fax:631-462-9890
Practice Address - Street 1:6277 JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-462-6644
Practice Address - Fax:631-462-9890
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009071363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant