Samuel Emmanuel Dickerson, LPN
Individual provider Active NPI Licensed Practical Nurse · Roosevelt, NY
NPI 1902139447 · NPPES record last updated Sep 16, 2009
Key facts
- NPI
- 1902139447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 241150-1 (NY)
- Practice address
- 95 W Greenwich Ave
Roosevelt, NY 11575-1035 - Phone
- (516) 481-3421
- Fax
- (516) 665-3798
- NPI assigned
- Sep 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 241150-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 241150-1 | NY | Yes |
Addresses
Primary practice location
95 W Greenwich Ave
Roosevelt, NY 11575-1035
Mailing address
95 W Greenwich Ave
Roosevelt, NY 11575-1035
Phone (516) 481-3421
Other providers in Roosevelt, NY
- Michael Delsignore
- Xiomara Diaz-Barrios
- Laurie Diaz
- Lorraine Marie Diaz
- Rachel Diaz
- Diane Divergilio-Antonette
- Maxine Dixon Williams
- Doing It the Wright Way, Inc.
- Meredith Dooley
- Gina Dorvil
All providers in Roosevelt, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.