Amanda Ammentorp, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

OT022056 Issued in PA

Practice address

3458 Neely Rd
MC Guire AFB, NJ 08641-5312

Phone

(866) 377-2778

NPI assigned

Feb 28, 2019

Last updated

Jun 30, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1952868606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "city": "MC GUIRE AFB",
            "state": "NJ",
            "postal_code": "086415312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "city": "MC GUIRE AFB",
            "state": "NJ",
            "postal_code": "086415312",
            "telephone_number": "866-377-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMMENTORP",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-28",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "MN",
            "license": "68149",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OT022056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952868606",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 87TH Medgrp-JB McGuire-Dix-Lakehurst
• Jess Barrows, LCSW, LCADC
• Jennifer Bench, R.D.H.
• Kimberley Dawn Bock Tabor, IDMT
• Stacey Keane Boden, LICSW
• Barbara D Broadt, RD

• Emergency Medicine Physician in McGuire AFB, NJ
• Providers in McGuire AFB, NJ by specialty
• Emergency Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.