Healthcare Provider Details

I. General information

NPI: 1275987315
Provider Name (Legal Business Name): AMY LYNN TENAGLIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE STE 199
NEW YORK NY
10032-3722
US

IV. Provider business mailing address

180 FORT WASHINGTON AVE STE 199
NEW YORK NY
10032-3722
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3535
  • Fax:
Mailing address:
  • Phone: 212-305-3535
  • Fax: 212-342-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number299225
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number299225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: