Provider Demographics
NPI:1114658796
Name:ANDAMON, AMALIA JOY
Entity Type:Individual
Prefix:
First Name:AMALIA JOY
Middle Name:
Last Name:ANDAMON
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 1:21726 138TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2608
Mailing Address - Country:US
Mailing Address - Phone:917-592-3682
Mailing Address - Fax:
Practice Address - Street 1:21726 138TH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11413-2608
Practice Address - Country:US
Practice Address - Phone:917-592-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist