Healthcare Provider Details

I. General information

NPI: 1013566504
Provider Name (Legal Business Name): AGNESE MIGNONE AMATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WESTCHESTER AVE STE N230
WHITE PLAINS NY
10604-3516
US

IV. Provider business mailing address

2 RICHBELL RD
WHITE PLAINS NY
10605-4111
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 914-325-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: