Provider Demographics
NPI:1730919861
Name:HARWOOD, SAMANTHA (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MEREDITH LN
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1007
Mailing Address - Country:US
Mailing Address - Phone:631-241-5902
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD STE 201
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5020
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354619-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily