Provider Demographics
NPI:1952533481
Name:DIETZ, AMY MICHELE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2506
Mailing Address - Country:US
Mailing Address - Phone:908-248-8795
Mailing Address - Fax:
Practice Address - Street 1:67 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1640
Practice Address - Country:US
Practice Address - Phone:908-654-3377
Practice Address - Fax:908-654-4044
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00220800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical