Individual
MS. AMANDA WIEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
462 1ST AVE, NEW YORK, NY 10016
(212) 562-4141
Mailing address
364 MACARTHUR AVE REAR, LONG BRANCH, NJ 07740-7638
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/28/2018
Last updated
08/13/2019
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