Individual ProviderSamantha AzadianStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1 Gustave Levy Place, New York, NY 10029(212) 241-6694PECOS EnrollmentBased on the most recent information from CMS, provider Samantha Azadian does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1093342537Provider TypeIndividualFull NameAzadian, SamanthaCredentialDDSGenderFemaleSole ProprietorNoEnumeration Date3/25/2020Last Updated3/25/2020Contact InformationPractice LocationPractice Address1 Gustave Levy Place, New York, NY 10029Phone(212) 241-6694FaxUnlisted FaxMailing LocationMailing AddressOne Gustave Levy Place Box 1076, New York, NY 10029Phone(212) 241-6694FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer