Healthcare Provider Details

I. General information

NPI: 1568849164
Provider Name (Legal Business Name): AMY SKARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2015
Last Update Date: 12/15/2024
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WILLIAM ST FL 7
NEW YORK NY
10038-5327
US

IV. Provider business mailing address

156 WILLIAM ST FL 7
NEW YORK NY
10038-5327
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number295484
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number295484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: