Provider Demographics
NPI:1740393842
Name:MA, AMY X (DNP)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:X
Last Name:MA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6936 HARROW ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5152
Mailing Address - Country:US
Mailing Address - Phone:718-909-3693
Mailing Address - Fax:
Practice Address - Street 1:6936 HARROW ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5152
Practice Address - Country:US
Practice Address - Phone:718-275-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02226222Medicaid
NY02226222Medicaid
NYP58035Medicare UPIN