Provider Demographics
NPI:1710224704
Name:ROSS, AMANDA S
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W END AVE
Mailing Address - Street 2:APARTMENT 7N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4801
Mailing Address - Country:US
Mailing Address - Phone:917-587-6500
Mailing Address - Fax:
Practice Address - Street 1:200 W END AVE
Practice Address - Street 2:APARTMENT 7N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4801
Practice Address - Country:US
Practice Address - Phone:917-587-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399164101251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare