Healthcare Provider Details

I. General information

NPI: 1548020357
Provider Name (Legal Business Name): AMBER STONE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BROADHOLLOW RD STE 10
MELVILLE NY
11747-4992
US

IV. Provider business mailing address

115 BROADHOLLOW RD STE 10
MELVILLE NY
11747-4992
US

V. Phone/Fax

Practice location:
  • Phone: 631-990-4352
  • Fax:
Mailing address:
  • Phone: 631-990-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANABELL MORALES
Title or Position: BOOK KEEPER
Credential:
Phone: 212-877-5500