Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 262062 | NY |
N | 208000000X | Pediatrician | A106141 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | 262062 | NY |
N | 2080P0204X | Pediatric Emergency Doctor | 41517 | AZ |
N | 2080P0204X | Pediatric Emergency Doctor | A106141 | CA |
NPI | 1053559732 |
---|---|
Provider Name | Amanda Jean Kasem |
First Address | Bronx, NY 10461-1138 |
Second Address | Bronx, NY 10461-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2009 |
Last Update Date | 21/07/2011 |