Healthcare Provider Details

I. General information

NPI: 1790861573
Provider Name (Legal Business Name): PETER EDWARD AMATO SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SHERMAN AVE
NEW HAVEN CT
06511-4301
US

IV. Provider business mailing address

10 WYNDEMERE
AVON CT
06001-3959
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-5173
  • Fax:
Mailing address:
  • Phone: 860-674-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number022896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: