Active NPI
Immacula Samson
- Adult Health Nurse Practitioner
- Jamaica, NY
National Provider Identifier
1023505955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 9854779
- Practice address
- 8268 164TH St
Jamaica, NY 11432-1121 - Phone
- (718) 883-3226
- NPI assigned
- Apr 17, 2018
- Last updated
- Jun 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 9854779 | NY | Primary |
Addresses
Primary practice location
8268 164TH St
Jamaica, NY 11432-1121
Mailing address
46 Ashley Dr
Valley Stream, NY 11580-2439
Phone (516) 943-3952
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 308392 | NY | MD | Physical Medicine & Rehabilitation Physician |
| 9854779 | NY | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1023505955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 ASHLEY DR",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115802439",
"telephone_number": "516-943-3952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8268 164TH ST",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114321121",
"telephone_number": "718-883-3226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMSON",
"first_name": "IMMACULA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-17",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NY",
"license": "9854779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.