Individual provider · Type 1 NPI
Manju Biju Sam
Adult Health Nurse Practitioner · Stony Brook, NY
NPI number
1265067466
Active
Practice location
101 Nicolls Rd
Stony Brook, NY 11794-1923
Mailing address
4 Berwyn Dr
Lake Ronkonkoma, NY 11779-1923
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner Primary | 363LA2200X | F309300-01 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1265067466
Manju Biju Sam's National Provider Identifier is 1265067466, issued on Mar 8, 2020. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Stony Brook, NY. The record was last updated on Nov 23, 2021.