MEDICARE: AMANDA HERON PARSONS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	242366	NY

General Provider Information

NPI Number	:	1083052302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HERON PARSONS M.D.

Provider Business Mailing Address
First Line	:	166 DUANE ST
Second Line	:	7C
City	:	NEW YORK
State	:	NY
Zip	:	10013-3398
Country	:	US
Telephone Number	:	917-576-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 DUANE ST
Second Line	:	7C
City	:	NEW YORK
State	:	NY
Zip	:	10013-3398
Country	:	US
Telephone Number	:	917-576-6940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2013
Last Update Date	:	06/09/2013

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