Provider Demographics
NPI:1962531343
Name:JILL A SAMO PHD LLC
Entity type:Organization
Organization Name:JILL A SAMO PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-538-0111
Mailing Address - Street 1:2109 PENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1415
Mailing Address - Country:US
Mailing Address - Phone:609-538-0111
Mailing Address - Fax:609-538-8218
Practice Address - Street 1:2109 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-1415
Practice Address - Country:US
Practice Address - Phone:609-538-0111
Practice Address - Fax:609-538-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091815Medicare PIN