Provider Demographics
NPI:1902858236
Name:SAMSON, ROVY SALENGA (PT)
Entity Type:Individual
Prefix:MR
First Name:ROVY
Middle Name:SALENGA
Last Name:SAMSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WOOD DUCK CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9522
Mailing Address - Country:US
Mailing Address - Phone:732-677-2839
Mailing Address - Fax:
Practice Address - Street 1:80 SCENIC DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5210
Practice Address - Country:US
Practice Address - Phone:732-863-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025536OtherNYS LICENSE
NJ40QA01144100OtherNJ LICENSE