1275081432 NPI number — AMANDA ROSE PHOENIX PHARM.D., BCACP, CDE

NPI Number: 1275081432
Health Care Provider/Practitioner: AMANDA ROSE PHOENIX PHARM.D., BCACP, CDE

NPI Number : 1275081432 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275081432",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PHOENIX",
    "FirstName": "AMANDA",
    "MiddleName": "ROSE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM.D., BCACP, CDE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MAIONE",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARM.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "56 BROOK MANOR LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLEASANTVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10570-2416",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-835-3311",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1650 GRAND CONCOURSE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRONX",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10457-7606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-835-3111",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/16/2016",
    "LastUpdateDate": "11/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "061184",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P2201X",
          "TaxonomyName": "Ambulatory Care Pharmacist",
          "LicenseNumber": "061184",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P1200X",
          "TaxonomyName": "Pharmacotherapy Pharmacist",
          "LicenseNumber": "061184",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}