Active NPI
Amanda Samaan
- Prosthodontics
- Staten Island, NY
National Provider Identifier
1376277467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 22DI02919200
- Practice address
- 15 Leonello LN
Staten Island, NY 10307-2412 - Phone
- (347) 996-9935
- NPI assigned
- Jul 13, 2022
- Last updated
- Jul 13, 2022
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 22DI02919200 | NJ | Primary |
Addresses
Primary practice location
15 Leonello LN
Staten Island, NY 10307-2412
Mailing address
15 Leonello LN
Staten Island, NY 10307-2412
Phone (347) 996-9935
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230615003260 | NJ | Order and Referring Only - Dentist | 5799143160 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02919200 | NJ | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1376277467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 LEONELLO LN",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103072412",
"telephone_number": "347-996-9935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 LEONELLO LN",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103072412",
"telephone_number": "347-996-9935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMAAN",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-13",
"last_updated": "2022-07-13",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NJ",
"license": "22DI02919200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.