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General NPI Number Information
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NPI Number | 1023860061
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Entity Type | Individual
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Provider Name | AMANDA EVE IMMERBLUM MS, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 256 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2766
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Country | US
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Telephone | 973-743-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 33 SMITH LN
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City | SOMERS
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State | NY
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Zip | 10589-1922
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Country | US
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Telephone | 914-844-6119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 353866
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15046300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 713221
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR24627100
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License Number State | NJ
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