Provider Demographics
NPI:1598015687
Name:WEBER, SAMANTHA MICHELLE (MSN, RN, APN-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:WEBER
Suffix:
Gender:
Credentials:MSN, RN, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FORESTER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1176
Mailing Address - Country:US
Mailing Address - Phone:845-202-3387
Mailing Address - Fax:332-239-4581
Practice Address - Street 1:13 FORESTER AVE STE 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1176
Practice Address - Country:US
Practice Address - Phone:845-202-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00389000363LA2200X
NY307483363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health