Basic Information
| Provider Information | |||||||||
| NPI: | 1043472004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARVEY | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | OSUNSANMI | ||||||||
| OtherFirstName: | SAMANTHA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WYCKOFF | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074811439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018479403 | ||||||||
| FaxNumber: | 2018470059 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAVEN AVE APT 5J | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100335307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473858944 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MA089398 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.