Healthcare Provider Details

I. General information

NPI: 1083592141
Provider Name (Legal Business Name): AMANDA LYNN GEORGIOPOULOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 GREEN TREE DR
JACKSON NJ
08527-4758
US

IV. Provider business mailing address

39 GREEN TREE DR
JACKSON NJ
08527-4758
US

V. Phone/Fax

Practice location:
  • Phone: 646-831-4381
  • Fax:
Mailing address:
  • Phone: 646-831-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353585-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15417500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: