Provider Demographics
NPI:1376683896
Name:AMAZALORSO, ROY (LAC LICENSED ACUPUNC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:AMAZALORSO
Suffix:
Gender:M
Credentials:LAC LICENSED ACUPUNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VALERIE LANE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-739-6387
Mailing Address - Fax:914-739-6387
Practice Address - Street 1:2117 CROMPOND ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:COATLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-737-0176
Practice Address - Fax:914-737-0383
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist