Provider Demographics
NPI:1902072192
Name:SAMANT, JYOTI S (MS)
Entity Type:Individual
Prefix:MRS
First Name:JYOTI
Middle Name:S
Last Name:SAMANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 OLD ROUTE 17
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-7013
Mailing Address - Country:US
Mailing Address - Phone:845-707-8400
Mailing Address - Fax:845-707-8916
Practice Address - Street 1:30 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1510
Practice Address - Country:US
Practice Address - Phone:845-292-9249
Practice Address - Fax:845-292-9249
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001306-1231H00000X
NY14000007728237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM90021Medicare UPIN