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General NPI Number Information
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NPI Number | 1104652585
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Entity Type | Individual
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Provider Name | AMANDA M TYLER
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Gender | Female
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 3333 NEW HYDE PARK RD STE 202
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1205
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Country | US
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Telephone | 516-775-6235
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Fax |
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Provider Business Mailing Address
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Address Line | 605 PAVONIA AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-2920
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 071693
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License Number State | NY
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