Provider Demographics
NPI:1871657890
Name:AMEN, MAISHA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAISHA
Middle Name:M
Last Name:AMEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TICHENOR TER
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3824
Mailing Address - Country:US
Mailing Address - Phone:973-372-2756
Mailing Address - Fax:
Practice Address - Street 1:20 TICHENOR TER
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3824
Practice Address - Country:US
Practice Address - Phone:973-372-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ71249163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health