Provider Demographics
NPI:1538586250
Name:SAMASSI, MABINTOU
Entity type:Individual
Prefix:
First Name:MABINTOU
Middle Name:
Last Name:SAMASSI
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 1:951 HOE AVE
Mailing Address - Street 2:2V
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3619
Mailing Address - Country:US
Mailing Address - Phone:917-412-7660
Mailing Address - Fax:
Practice Address - Street 1:951 HOE AVE
Practice Address - Street 2:2V
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3619
Practice Address - Country:US
Practice Address - Phone:917-412-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse