Healthcare Provider Details

I. General information

NPI: 1952305229
Provider Name (Legal Business Name): DR. AFRIYE AMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GORGE RD 13
CLIFFSIDE PARK NJ
07010-2764
US

IV. Provider business mailing address

300 GORGE ROAD SUITE 13
CLIFFSIDE PARK NJ
07010
US

V. Phone/Fax

Practice location:
  • Phone: 646-325-3993
  • Fax:
Mailing address:
  • Phone: 646-325-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07279100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: