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General NPI Number Information
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NPI Number | 1699288795
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Entity Type | Organization
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Legal Business Name | AMARANTH PEDIATRIC HEALTH, PC
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Dates
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Enumeration Date | 11/10/2017
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Last Update Date | 11/10/2017
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Provider Practice Location Address
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Address Line | 210 CANAL ST RM 305
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City | NEW YORK
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State | NY
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Zip | 10013-4186
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Country | US
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Telephone | 212-925-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 85 BARROW ST APT 2R
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City | NEW YORK
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State | NY
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Zip | 10014-3716
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Country | US
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Telephone | 201-982-0628
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHERYL WU
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Credential | MD
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Telephone | 212-925-4993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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