Healthcare Provider Details

I. General information

NPI: 1659887032
Provider Name (Legal Business Name): AMEN CLINICS, INC NYC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E 45TH ST RM 410
NEW YORK NY
10017-3303
US

IV. Provider business mailing address

228 E 45TH ST RM 410
NEW YORK NY
10017-3303
US

V. Phone/Fax

Practice location:
  • Phone: 646-736-3110
  • Fax: 646-236-8691
Mailing address:
  • Phone: 646-736-3110
  • Fax: 646-236-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA T MCCORMICK
Title or Position: CORPORATE TRAINER
Credential:
Phone: 703-880-4000