Individual
AMANDA E MARENGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
016744
NY
363A00000X
Physician Assistant
Primary
016744-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03746283
—
NY
Enumeration date
07/22/2013
Last updated
07/22/2026
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