1922057975 NPI number — DR. AMELIA G BARTOLONE OD

Table of content: DR. AMELIA G BARTOLONE OD (NPI 1922057975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922057975 NPI number — DR. AMELIA G BARTOLONE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTOLONE
Provider First Name:
AMELIA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLEBIEWSKI
Provider Other First Name:
AMELIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922057975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 SUN CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONE RIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12484-5630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
848-797-7161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 WASHINGTON ST STE L03
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-443-6800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

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: 152WP0200X , with the licence number:  T005732 , 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)

  • Identifier: 00244528 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".