Healthcare Provider Details

I. General information

NPI: 1619175999
Provider Name (Legal Business Name): AMY HOVDESTAD HATCH NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

28 CAROL DR
MOUNT KISCO NY
10549-4017
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-8600
  • Fax:
Mailing address:
  • Phone: 718-419-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF350276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: