Healthcare Provider Details

I. General information

NPI: 1306722459
Provider Name (Legal Business Name): AMY NIASS I RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 CROES AVE APT 6E
BRONX NY
10472-4540
US

IV. Provider business mailing address

1220 CROES AVE APT 6E
BRONX NY
10472-4540
US

V. Phone/Fax

Practice location:
  • Phone: 917-680-0276
  • Fax:
Mailing address:
  • Phone: 917-680-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number975609-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: