Provider Demographics
NPI:1952380321
Name:FALIKS, SAMANTHA RISA (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RISA
Last Name:FALIKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3212
Mailing Address - Country:US
Mailing Address - Phone:516-944-0500
Mailing Address - Fax:516-944-0501
Practice Address - Street 1:174 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3212
Practice Address - Country:US
Practice Address - Phone:516-944-0500
Practice Address - Fax:516-944-0501
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027175-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27V11Medicare PIN