Provider Demographics
NPI:1720377153
Name:IGITYAN, AMALYA (DDS)
Entity Type:Individual
Prefix:
First Name:AMALYA
Middle Name:
Last Name:IGITYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OCEANA DR E
Mailing Address - Street 2:APT #2H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6681
Mailing Address - Country:US
Mailing Address - Phone:646-238-2020
Mailing Address - Fax:
Practice Address - Street 1:125 AMHERST ST
Practice Address - Street 2:2FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4114
Practice Address - Country:US
Practice Address - Phone:646-238-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0563761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics