Provider Demographics
NPI:1891169553
Name:STORY, SAMANTHA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STORY
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ROEBLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5403
Mailing Address - Country:US
Mailing Address - Phone:718-388-4788
Mailing Address - Fax:
Practice Address - Street 1:219 ROEBLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5403
Practice Address - Country:US
Practice Address - Phone:718-388-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist