Healthcare Provider Details

I. General information

NPI: 1619160595
Provider Name (Legal Business Name): AMOS C GO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

161 W 53RD ST
BAYONNE NJ
07002-2166
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-8205
  • Fax:
Mailing address:
  • Phone: 201-562-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013244-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number013244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: