Provider Demographics
NPI:1366224297
Name:GALUCCI, SAMANTHA (AGNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GALUCCI
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PARAGON WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7805
Mailing Address - Country:US
Mailing Address - Phone:732-462-9800
Mailing Address - Fax:
Practice Address - Street 1:4 PARAGON WAY STE 300
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7805
Practice Address - Country:US
Practice Address - Phone:732-462-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14915800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner