=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588224182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID AMSTER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2019
-----------------------------------------------------
Last Update Date | 06/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 W PASSAIC ST
-----------------------------------------------------
City | ROCHELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07662-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-379-8301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 AMSTERDAM AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-379-8301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------