Basic Information
| Provider Information | |||||||||
| NPI: | 1871930792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSOLINO | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND STREET, 3RD FL | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873906 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 ROUTE 59 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109014927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454942172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2013 | ||||||||
| LastUpdateDate: | 03/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 646340 | NY | N | Nursing Service Providers | Registered Nurse | Pediatrics | 363LF0000X | F340318-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.