MEDICARE: MS. AMANDA LEFKOWITZ RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	678695	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4022306	NY

General Provider Information

NPI Number	:	1093168817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA LEFKOWITZ RN

Provider Business Mailing Address
First Line	:	314 DEMOTT AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-1854
Country	:	US
Telephone Number	:	516-996-1178
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 DEMOTT AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-1854
Country	:	US
Telephone Number	:	516-996-1178
Fax Number	:

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

Provider Enumeration Date	:	07/16/2016
Last Update Date	:	10/11/2017

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