Provider Demographics
NPI:1093790610
Name:MARDINI, AMAL D
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:D
Last Name:MARDINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4406
Mailing Address - Country:US
Mailing Address - Phone:716-817-6729
Mailing Address - Fax:716-817-9528
Practice Address - Street 1:4446 MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4406
Practice Address - Country:US
Practice Address - Phone:716-817-6729
Practice Address - Fax:716-817-9528
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0085751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU65648Medicare UPIN
NYBA0662Medicare PIN