Provider Demographics
NPI:1992299218
Name:STUEK, SAMANTHA JAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JAYNE
Last Name:STUEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EARLE OVINGTON BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3645
Mailing Address - Country:US
Mailing Address - Phone:516-222-8881
Mailing Address - Fax:
Practice Address - Street 1:333 EARLE OVINGTON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3645
Practice Address - Country:US
Practice Address - Phone:516-222-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY316650207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program