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General NPI Number Information
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NPI Number | 1740579408
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Entity Type | Individual
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Provider Name | FREDERICK DONATO AMOG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1 BROOKDALE PLZ
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City | BROOKLYN
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State | NY
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Zip | 11212-3139
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Country | US
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Telephone | 718-240-6387
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Fax |
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Provider Business Mailing Address
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Address Line | 423 OCEAN PKWY APT 4B
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City | BROOKLYN
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State | NY
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Zip | 11218-5134
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Country | US
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Telephone | 347-240-0302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N9161
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 003773
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License Number State | NY
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