Provider Demographics
NPI:1124811021
Name:BIRUNG, SAMANTHA MALAYAO
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MALAYAO
Last Name:BIRUNG
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 1:2112 LURTING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1214
Mailing Address - Country:US
Mailing Address - Phone:951-705-4060
Mailing Address - Fax:
Practice Address - Street 1:333 7TH AVE FL 18
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5086
Practice Address - Country:US
Practice Address - Phone:917-286-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029426225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist