Provider Demographics
NPI:1376567321
Name:AMENDOLA, CHRISTINE LAZAROS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LAZAROS
Last Name:AMENDOLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:JUDITH
Other - Last Name:LAZAROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1007
Mailing Address - Country:US
Mailing Address - Phone:914-769-1994
Mailing Address - Fax:
Practice Address - Street 1:56 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1007
Practice Address - Country:US
Practice Address - Phone:914-769-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08338Medicare UPIN