Nidhin Samuel

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F403257-01 Issued in NY

Practice address

1 Long Beach Rd
Island Park, NY 11558-2254

Phone

(516) 432-0300

NPI assigned

Oct 1, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Tellanid Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
  • NPI 1881347904
  NPD Authorized official

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1306518915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LONG BEACH RD",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "115582254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LONG BEACH RD",
            "city": "ISLAND PARK",
            "state": "NY",
            "postal_code": "115582254",
            "telephone_number": "516-432-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "NIDHIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F403257-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Rosario
• Caitlin Rossi
• Kate-Lynn Rufle
• Ryan K Albrecht LCSW PLLC
• Greg P Saggio, D.O.
• Steven Schrank, DPT
• Seaside Physical Therapy P.C.
• Serenity Zone LCSW PLLC
• Serenity Zone LCSW PLLC
• Robert Serwetz, M. ED.

• Psychiatric/Mental Health Nurse Practitioner in Island Park, NY
• Providers in Island Park, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.