Provider Demographics
NPI:1902652605
Name:RIPPS-PALACIOS, SAMANTHA FEMALE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FEMALE
Last Name:RIPPS-PALACIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BAYARD LN N
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3409
Mailing Address - Country:US
Mailing Address - Phone:845-708-9073
Mailing Address - Fax:
Practice Address - Street 1:100 MCCLELLEN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1555
Practice Address - Country:US
Practice Address - Phone:201-768-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09209900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty