Provider Demographics
NPI:1568746196
Name:AMADOR, GILBERTO (RSA)
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1716
Mailing Address - Country:US
Mailing Address - Phone:201-835-3067
Mailing Address - Fax:201-840-8516
Practice Address - Street 1:569 OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1716
Practice Address - Country:US
Practice Address - Phone:201-835-3067
Practice Address - Fax:201-840-8516
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO000092-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant