Healthcare Provider Details

I. General information

NPI: 1083981344
Provider Name (Legal Business Name): AMSTERDAM MEDICAL PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 AMSTERDAM AVE STE M1
NEW YORK NY
10033-7362
US

IV. Provider business mailing address

2360 AMSTERDAM AVE STE M1
NEW YORK NY
10033-7362
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-0559
  • Fax: 212-740-4930
Mailing address:
  • Phone: 212-923-0559
  • Fax: 212-740-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190569
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARDO L PIGNANELLI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 212-923-0559