Provider Demographics
NPI:1861826091
Name:SAMMARO, SAMANTHA (DPT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:SAMMARO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 ALLWOOD RD FL 1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1988
Mailing Address - Country:US
Mailing Address - Phone:973-928-3590
Mailing Address - Fax:973-928-3589
Practice Address - Street 1:935 ALLWOOD RD FL 1
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1988
Practice Address - Country:US
Practice Address - Phone:973-928-3590
Practice Address - Fax:973-928-3589
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01512600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ204681Medicare PIN