Provider Demographics
NPI:1679089726
Name:AMAZAN, ROD (NP)
Entity Type:Individual
Prefix:MR
First Name:ROD
Middle Name:
Last Name:AMAZAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROCKLAND GARDEN APT # 101
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2513
Mailing Address - Country:US
Mailing Address - Phone:845-499-6974
Mailing Address - Fax:
Practice Address - Street 1:1265 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3501
Practice Address - Country:US
Practice Address - Phone:718-901-8824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402282-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry