Provider Demographics
NPI:1972205318
Name:SAMAROO, LAKSHMAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:LAKSHMAN
Middle Name:
Last Name:SAMAROO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELGAR PL APT 28L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5044
Mailing Address - Country:US
Mailing Address - Phone:917-495-5398
Mailing Address - Fax:
Practice Address - Street 1:100 ELGAR PL APT 28L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5044
Practice Address - Country:US
Practice Address - Phone:917-495-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432554363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care