Individual provider Active NPI

Amanda Mirmanesh, DO

  • Obstetrics & Gynecology Physician
  • Vineland, NJ
National Provider Identifier
1871158030
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
25MB11854600 Issued in NJ
Practice address
2950 College Dr Ste 2D
Vineland, NJ 08360-6933
Phone
(856) 641-6313
Fax
(856) 497-5350
NPI assigned
May 3, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 25MB11854600 NJ Primary

Addresses

Primary practice location

2950 College Dr Ste 2D
Vineland, NJ 08360-6933

Mailing address

1120 Delsea Dr N
Glassboro, NJ 08028-1444
Phone (856) 507-2783

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231012000367 NJ Practitioner - Obstetrics/Gynecology 6002261948 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Philadelphia College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inspira Health Network Medical Group PCGroup PAC ID 4880797570, 238 clinicians

Practice addresses (Care Compare)

2950 College Dr
Suite 2D
Vineland, NJ 08360-6933
Phone (856) 641-6313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Inspira Health Network Medical Group, P.C. Multi-Specialty CurrentSince Sep 1, 2023 Accepting new patients

Locations

1120 Delsea Dr N
Glassboro, NJ 08028
Phone (856) 205-7071

798 Centerton Rd
Pittsgrove, NJ 08318
Phone (856) 358-6161

2950 College Dr
Ste 2D
Vineland, NJ 08360
Phone (856) 641-6313

1505 W Sherman Ave
Vineland, NJ 08360
Phone (856) 451-6600

2466 E Chestnut Ave
Ste 2
Vineland, NJ 08361
Phone (856) 896-2814

17 W Red Bank Ave
Ste 104
Woodbury, NJ 08096
Phone (856) 848-0665

Organizations & group practices 2

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": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1871158030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 DELSEA DR N",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080281444",
            "telephone_number": "856-507-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 COLLEGE DR STE 2D",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606933",
            "telephone_number": "856-641-6313",
            "fax_number": "856-497-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRMANESH",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-03",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MB11854600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.