Jeanette O Samuels, N.P.

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

F360016-1 Issued in NY

Practice address

225 Rabro Drive East
Hauppauge, NY 11788-4290

Phone

(631) 853-3020

Fax

(631) 853-3051

NPI assigned

Nov 2, 2006

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)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700965787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 HICKORY ST",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117297014",
            "telephone_number": "631-242-1520",
            "fax_number": "631-940-3532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 RABRO DRIVE EAST",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884290",
            "telephone_number": "631-853-3020",
            "fax_number": "631-853-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "JEANETTE",
        "middle_name": "O",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "F360016-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Nurse Practitioner in Hauppauge, NY
• Providers in Hauppauge, NY by specialty
• Obstetrics & Gynecology Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.