Provider Demographics
NPI:1578716403
Name:PINE, AMY MARIE (MS, RPA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:PINE
Suffix:
Gender:F
Credentials:MS, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STANDART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1508
Mailing Address - Country:US
Mailing Address - Phone:315-255-1100
Mailing Address - Fax:315-255-1322
Practice Address - Street 1:144 STANDART AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1509
Practice Address - Country:US
Practice Address - Phone:315-255-1100
Practice Address - Fax:315-255-1322
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003474Medicare PIN