MEDICARE: MRS. JOHANNA AMAR- EICHENWALD PA

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
1	363A00000X	Physician Assistant	012031	NY

General Provider Information

NPI Number	:	1861689234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHANNA AMAR- EICHENWALD PA

Provider Business Mailing Address
First Line	:	240 E PALISADE AVE APT 19H
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-3161
Country	:	US
Telephone Number	:	718-371-8556
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E PALISADE AVE APT 19H
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-3161
Country	:	US
Telephone Number	:	718-371-8556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	08/19/2015

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