Individual provider Active NPI

Amanda Sue Marino, C.R.N.P.

  • Obstetrics & Gynecology Nurse Practitioner
  • Allentown, PA
National Provider Identifier
1053700120
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
SP012936 Issued in PA
Practice address
1627 Chew St FL 1
Allentown, PA 18102-3648
Phone
(610) 402-1600
NPI assigned
Jan 13, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X SP012936 PA Primary

Addresses

Primary practice location

1627 Chew St FL 1
Allentown, PA 18102-3648

Mailing address

700 Coventry Dr
Phillipsburg, NJ 08865-1972
Phone (908) 454-4666

Other practice location 1

700 Coventry Dr
Phillipsburg, NJ 08865-1972
Phone (908) 454-4666

Other identifiers 1

IdentifierTypeStateIssuer
0495492MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150408000916 PA Practitioner - Nurse Practitioner 2163749755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1627 Chew St
Allentown, PA 18102-3648

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP012936PAMDObstetrics & Gynecology Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: abloom34137@direct2.lvhn.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1053700120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 COVENTRY DR",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088651972",
            "telephone_number": "908-454-4666",
            "fax_number": "908-454-2332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 CHEW ST FL 1",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181023648",
            "telephone_number": "610-402-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Coventry Dr",
            "address_purpose": "LOCATION",
            "city": "Phillipsburg",
            "state": "NJ",
            "postal_code": "088651972",
            "country_code": "US",
            "telephone_number": "908-454-4666",
            "fax_number": "908-454-2332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARINO",
        "first_name": "AMANDA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-13",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "PA",
            "license": "SP012936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0495492",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.