Provider Demographics
NPI:1154747533
Name:BOMZER, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BOMZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 57TH ST
Mailing Address - Street 2:APT 16S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1063
Mailing Address - Country:US
Mailing Address - Phone:845-729-2266
Mailing Address - Fax:
Practice Address - Street 1:601 W 57TH ST
Practice Address - Street 2:APT 16S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1063
Practice Address - Country:US
Practice Address - Phone:845-729-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist