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NPI Code Detail

MEDICARE: AMANDA NEGLIA TIETZER

MEDICARE: AMANDA NEGLIA TIETZER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist016666NY

General Provider Information

NPI Number : 1053600023
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NEGLIA TIETZER
Provider Business Mailing Address
First Line : 231 NOEL ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6072
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8 JOHNSON ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-1148
Country : US
Telephone Number : 718-979-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2011
Last Update Date : 04/05/2023

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Directions to “ AMANDA NEGLIA TIETZER ” Practice Location

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