Provider Demographics
NPI:1699288795
Name:AMARANTH PEDIATRIC HEALTH, PC
Entity type:Organization
Organization Name:AMARANTH PEDIATRIC HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-925-4993
Mailing Address - Street 1:85 BARROW ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3716
Mailing Address - Country:US
Mailing Address - Phone:201-982-0628
Mailing Address - Fax:
Practice Address - Street 1:210 CANAL ST RM 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4186
Practice Address - Country:US
Practice Address - Phone:212-925-4993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty