Healthcare Provider Details

I. General information

NPI: 1366977878
Provider Name (Legal Business Name): JEFFREY AMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 KANAGAWA
YOKOSUKA INAOKACHO
2380002
JP

IV. Provider business mailing address

PSC 475 BOX 8
FPO AP
96350-9998
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-8747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number295120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: