Provider Demographics
NPI:1679584296
Name:AMITAY, TAMAR (MSPT)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:AMITAY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BROADWAY
Mailing Address - Street 2:# 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-254-7750
Mailing Address - Fax:212-254-1202
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:# 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:212-254-7750
Practice Address - Fax:212-254-1202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009326-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ01Y31Medicare PIN