Healthcare Provider Details

I. General information

NPI: 1184201543
Provider Name (Legal Business Name): AMANDA MARGARET PERRY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MADISON AVE FL 4
NEW YORK NY
10029-6514
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1273
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-2087
  • Fax:
Mailing address:
  • Phone: 212-241-2087
  • Fax: 212-987-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number350032
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: