Individual provider Active NPI

Alexandra Samadi

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1992401079
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
351227 Issued in NY
Practice address
40 W Brighton Ave Ste 103
Brooklyn, NY 11224-4901
Phone
(718) 996-2260
Fax
(718) 996-1123
NPI assigned
Feb 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 351227 NY Primary

Addresses

Primary practice location

40 W Brighton Ave Ste 103
Brooklyn, NY 11224-4901

Mailing address

48 Columbia Ave
Staten Island, NY 10305-3740
Phone (917) 836-0664

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230712001370 NY Practitioner - Nurse Practitioner 5991165714 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
351227NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Century Medical & Dental Center Inc CurrentSince May 1, 2023 Accepting new patients
Brooklyn Eye and Ear Medical PC CurrentSince Dec 1, 2023 Accepting new patients
Suny Downstate Medical Center PastSince May 1, 2023 Accepting new patients

Locations

260 Avenue X
Brooklyn, NY 11223
Phone (718) 336-8855

40 W Brighton Ave
Ste 103
Brooklyn, NY 11224
Phone (718) 743-0464

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1992401079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 COLUMBIA AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053740",
            "telephone_number": "917-836-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 W BRIGHTON AVE STE 103",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112244901",
            "telephone_number": "718-996-2260",
            "fax_number": "718-996-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMADI",
        "first_name": "ALEXANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.