Provider Demographics
NPI:1851045165
Name:SERRONE, SAMANTHA (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SERRONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EUSTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4108
Mailing Address - Country:US
Mailing Address - Phone:516-351-5941
Mailing Address - Fax:
Practice Address - Street 1:120 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3443
Practice Address - Country:US
Practice Address - Phone:516-351-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310667363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty