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1790910131
SAMANTHA DERISO
STATEN ISLAND, NY
NPI
1790910131
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: NY 295075)
Enumeration Date
2009-05-28
Last Update Date
2009-05-28
Business Address
-- SAMANTHA DERISO LPN
1477 HYLAN BLVD
STATEN ISLAND, NY 10305-1906
Phone number: 718-979-6900
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Mailing Address
-- SAMANTHA DERISO LPN
316 ADAMS AVE
STATEN ISLAND, NY 10306-5216
Phone number: 917-495-9906
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