Provider Demographics
NPI:1962644351
Name:BOYD, SAMANTHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 ROUTE 9 N
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3324
Mailing Address - Country:US
Mailing Address - Phone:732-905-1110
Mailing Address - Fax:732-905-7885
Practice Address - Street 1:4645 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3324
Practice Address - Country:US
Practice Address - Phone:732-905-1110
Practice Address - Fax:732-905-7885
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00305200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ186296QHJOtherMEDICARE PTAN