Healthcare Provider Details

I. General information

NPI: 1154453207
Provider Name (Legal Business Name): JOSE A AMAT M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SHERMAN AVE
NEW YORK NY
10040-1602
US

IV. Provider business mailing address

2317 LACONIA AVE
BRONX NY
10469-1442
US

V. Phone/Fax

Practice location:
  • Phone: 212-942-1493
  • Fax: 212-567-2019
Mailing address:
  • Phone: 718-798-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number224532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: