Provider Demographics
NPI:1932250107
Name:MAZAHREH, SAMER B (DNP, FNP-C, DC)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:B
Last Name:MAZAHREH
Suffix:
Gender:M
Credentials:DNP, FNP-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7114
Mailing Address - Country:US
Mailing Address - Phone:914-654-1100
Mailing Address - Fax:914-654-9715
Practice Address - Street 1:634 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7114
Practice Address - Country:US
Practice Address - Phone:914-654-1100
Practice Address - Fax:914-654-9715
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009616111N00000X
NY343176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2D311Medicare ID - Type UnspecifiedCHIROPRACTIC
NYU78628Medicare UPIN