Provider Demographics
NPI:1952305229
Name:AMERSON, AFRIYE
Entity Type:Individual
Prefix:DR
First Name:AFRIYE
Middle Name:
Last Name:AMERSON
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 1:300 GORGE ROAD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:646-325-3993
Mailing Address - Fax:
Practice Address - Street 1:300 GORGE RD 13
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2764
Practice Address - Country:US
Practice Address - Phone:646-325-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07279100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2809254OtherAETNA HMO #
NJ0298132OtherGHI PPO #
NJ33386OtherUHP #
NJ160055936OtherRAILROAD MCR #
NJ7223339OtherAETNA PPO #
NJP2640441OtherOXFORD PROVIDER #
NJ646E41OtherEMPIRE BC/BS #
NJJ35676OtherHEALTHNET #
NJ2283211000OtherAMERIHEALTH #
NJ160055936OtherRAILROAD MCR #
NJH44487Medicare UPIN