=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467247924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMG PHARMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 MIDDLE NECK RD
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11021-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-855-0081
-----------------------------------------------------
Fax | 516-855-0082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 MIDDLE NECK RD
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11021-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-855-0081
-----------------------------------------------------
Fax | 516-855-0082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL GIA ISRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-855-0081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------