Provider Demographics
NPI:1912377656
Name:GARIGLIANO, SAMANTHA ERIN (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ERIN
Last Name:GARIGLIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:ADRIAANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2115
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:845-818-7555
Practice Address - Street 1:111 MALTESE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2115
Practice Address - Country:US
Practice Address - Phone:845-342-4774
Practice Address - Fax:845-818-7555
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04386476Medicaid