Healthcare Provider Details

I. General information

NPI: 1770939274
Provider Name (Legal Business Name): AMANDA SPINNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH ST STE 2200
NEW BRUNSWICK NJ
08901-1935
US

IV. Provider business mailing address

89 FRENCH ST STE 2200
NEW BRUNSWICK NJ
08901-1935
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7875
  • Fax:
Mailing address:
  • Phone: 732-235-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11222200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA11222200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: