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Jonathan Hendrickson Samuel

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

475 Seaview Ave, Staten Island, NY 10305-3436

PECOS Enrollment

This provider is enrolled in PECOS as JONATHAN SAMUEL.

Based on the most recent information from CMS, provider Jonathan Hendrickson Samuel is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1578202891
Provider Type
Individual
Full Name
Samuel, Jonathan Hendrickson
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
6/3/2022
Last Updated
6/3/2022

Contact Information

Practice Location

475 Seaview Ave, Staten Island, NY 10305-3436

(718) 226-9000

Unlisted Fax

Mailing Location

475 Seaview Ave, Staten Island, NY 10305-3436

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Jonathan Hendrickson Samuel

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Suarez, Michelle

Harris, Karen

Cheung, Jason

Mishiyeva, Dina

Silfen, Shelley G

Lavallee, David Norman

Cavagnaro-Irvine, Dyane Lyn

Russo, James Vincent

Buckley Jamison, Moriah

Feyijinmi, Olusegun I