Provider Demographics
NPI:1760228381
Name:GOSAL, SAMANDEEP
Entity type:Individual
Prefix:
First Name:SAMANDEEP
Middle Name:
Last Name:GOSAL
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 1:538 FISHKILL RD N
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-3754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:538 FISHKILL RD N
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-3754
Practice Address - Country:US
Practice Address - Phone:845-705-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist