Basic Information
| Provider Information | |||||||||
| NPI: | 1255694949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUCETTE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 140 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | FLORHAM PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079321049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734049700 | ||||||||
| FaxNumber: | 9733774709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | P13-00507 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207R00000X | MT201224 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207L00000X | 25MA09842700 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.