Basic Information
| Provider Information | |||||||||
| NPI: | 1144647520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EARLEY | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | QUINN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 MONTAUK AVE | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063204700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605407430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473189300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125066054 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 69321 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 036143711 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.