Healthcare Provider Details

I. General information

NPI: 1841339702
Provider Name (Legal Business Name): AMANDA R GANEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 ROUTE 202
SOMERS NY
10589-3207
US

IV. Provider business mailing address

342 ROUTE 202
SOMERS NY
10589-3207
US

V. Phone/Fax

Practice location:
  • Phone: 845-725-0222
  • Fax: 845-725-0233
Mailing address:
  • Phone: 845-725-0222
  • Fax: 845-725-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number226951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: