Manju Biju Sam

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F309300-01 Issued in NY

Practice address

101 Nicolls Rd
Stony Brook, NY 11794-1923

Phone

(631) 632-6868

NPI assigned

Mar 8, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: manju.sam@direct.stonybrookmedicine.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Brook Internists, University Faculty Practice Corporation

  • Internal Medicine Physician
  • Stony Brook, NY
  • NPI 1821035601
  Medicare reassignment NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Cardiac Rehabilitation Registered Nurse
  • Stony Brook, NY
  • NPI 1295778371
  NPD
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Stony Brook, NY
  • NPI 1972523348
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1265067466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 BERWYN DR",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117791923",
            "telephone_number": "631-525-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117941923",
            "telephone_number": "631-632-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "MANJU",
        "middle_name": "BIJU",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-08",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F309300-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel H Saltz, MD
• Mary M Saltz, MD
• Deborah Salvatore, RD
• Joann N Salvemini, MD
• Richard James Salway, M.D.
• Jennifer Amanda Samaniego
• Chabidou Sampain, FNP
• Sherene Samu, PHARM.D.
• Betty Samuel, DDS
• Joan C Samuels, PA

• Adult Health Nurse Practitioner in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; 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.

Verify at the official NPI Registry.