Active NPI
Amanda Moberg Wilson, MD
- Psychiatry Physician
- New York, NY
National Provider Identifier
1003073545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- DO NOT HAVE ONE-PGY1
- Practice address
- 21 W 86TH St
Suite 209
New York, NY 10024-3671 - Phone
- (917) 715-2886
- NPI assigned
- May 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | DO NOT HAVE ONE-PGY1 | NY | Primary |
Addresses
Primary practice location
21 W 86TH St
Suite 209
New York, NY 10024-3671
Mailing address
1160 5TH Ave
# 407
New York, NY 10029-6928
Phone (917) 715-2886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2015 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO NOT HAVE ONE-PGY1 | NY | MD | Psychiatry Physician |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344988800000",
"number": "1003073545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1160 5TH AVE",
"address_2": "# 407",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100296928",
"telephone_number": "917-715-2886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 W 86TH ST",
"address_2": "SUITE 209",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100243671",
"telephone_number": "917-715-2886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMANDA",
"middle_name": "MOBERG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-21",
"last_updated": "2012-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "DO NOT HAVE ONE-PGY1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.