Provider Demographics
NPI:1821199498
Name:AMALATHAS, SIMONA GABRIELA (MD)
Entity Type:Individual
Prefix:
First Name:SIMONA
Middle Name:GABRIELA
Last Name:AMALATHAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 IBM RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5461
Mailing Address - Country:US
Mailing Address - Phone:845-463-4044
Mailing Address - Fax:845-463-0945
Practice Address - Street 1:22 IBM RD STE 104A
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5461
Practice Address - Country:US
Practice Address - Phone:845-463-4044
Practice Address - Fax:845-463-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2128662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207168OtherMVP
3186053OtherGHI BMP
P-2850729OtherOXFORD
10040052OtherCDPHP
NY71M562Medicare ID - Type Unspecified
3186053OtherGHI BMP