Healthcare Provider Details

I. General information

NPI: 1851377576
Provider Name (Legal Business Name): AMANDA M. LAIRD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE
BRONX NY
10467-2404
US

IV. Provider business mailing address

320 E 58TH ST APT 3H
NEW YORK NY
10022-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002-00135
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0200135
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301096481
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP1559
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10051400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: