Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 309158 | NY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 309158 | NY |
NPI | 1215465109 |
---|---|
Provider Name | Amanda Orengo |
First Address | Middletown, NY 10941-4057 |
Second Address | Newburgh, NY 12550-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 10/06/2021 |