Individual provider Active NPI

Amanda Rachel Anaya, NP

  • Pediatric Adolescent Medicine Physician
  • Holbrook, NY
National Provider Identifier
1558082149
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
F383357-01 Issued in NY
Practice address
270 Union Ave
Holbrook, NY 11741-1823
Phone
(631) 588-4442
NPI assigned
Sep 12, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X F383357-01 NY Primary

Addresses

Primary practice location

270 Union Ave
Holbrook, NY 11741-1823

Mailing address

62 King Arthurs CT N
Saint James, NY 11780-3161
Phone (631) 241-2454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20231129000836 NY Practitioner - Nurse Practitioner 4789032988 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F383357-01NYMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 10, 2023 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 10, 2023 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients
Prohealth Care Associates, LLP Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Philadelphia, PA 19195

Organizations & group practices 4

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": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1558082149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 KING ARTHURS CT N",
            "city": "SAINT JAMES",
            "state": "NY",
            "postal_code": "117803161",
            "telephone_number": "631-241-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411823",
            "telephone_number": "631-588-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANAYA",
        "first_name": "AMANDA",
        "middle_name": "RACHEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "F383357-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

Sources for this page

Verify at the official NPI Registry.