Healthcare Provider Details

I. General information

NPI: 1427134790
Provider Name (Legal Business Name): AMY HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONTEFIORE SCHOOL HEALTH PROGRAM 111 EAST 210TH STREET
BRONX NY
10467
US

IV. Provider business mailing address

14 EILER LN
IRVINGTON NY
10533-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4060
  • Fax:
Mailing address:
  • Phone: 646-391-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: