1376683896 NPI number — DR. ROY AMAZALORSO LAC LICENSED ACUPUNC

Table of content: DR. ROY AMAZALORSO LAC LICENSED ACUPUNC (NPI 1376683896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376683896 NPI number — DR. ROY AMAZALORSO LAC LICENSED ACUPUNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAZALORSO
Provider First Name:
ROY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LAC LICENSED ACUPUNC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376683896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 VALERIE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTLANDT MANOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-739-6387
Provider Business Mailing Address Fax Number:
914-739-6387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 CROMPOND ROAD
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
COATLANDT MANOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-737-0176
Provider Business Practice Location Address Fax Number:
914-737-0383
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  000204 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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