Provider Demographics
NPI:1093977019
Name:AMADI, MARIETTE YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIETTE
Middle Name:YVONNE
Last Name:AMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 UNIVERSITY PLAZA
Mailing Address - Street 2:SUITE 100 #29
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1914
Mailing Address - Country:US
Mailing Address - Phone:908-578-2144
Mailing Address - Fax:732-379-4538
Practice Address - Street 1:2 UNIVERSITY PLZ
Practice Address - Street 2:SUITE 100 #29
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6208
Practice Address - Country:US
Practice Address - Phone:908-578-2144
Practice Address - Fax:732-379-4538
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265667207R00000X
NJ25MA08528000208M00000X
NJ302868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08528000OtherSTATE LICENSE