Provider Demographics
NPI:1780950915
Name:KOKORIS, SAMANTHA (MSCCC/SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:KOKORIS
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1022
Mailing Address - Country:US
Mailing Address - Phone:516-390-7195
Mailing Address - Fax:
Practice Address - Street 1:26 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1022
Practice Address - Country:US
Practice Address - Phone:516-390-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist