Healthcare Provider Details

I. General information

NPI: 1659005189
Provider Name (Legal Business Name): AMY CLAIRE HOUSTON MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/21/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W 56TH ST
NEW YORK NY
10019-3800
US

IV. Provider business mailing address

156 W 56TH ST
NEW YORK NY
10019-3800
US

V. Phone/Fax

Practice location:
  • Phone: 212-662-9200
  • Fax:
Mailing address:
  • Phone: 212-662-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: