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
State | License ID | Taxonomies |
---|---|---|
NY | 212866 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 207168 | Other | MVP |
3186053 | Other | GHI BMP | |
P-2850729 | Other | OXFORD | |
10040052 | Other | CDPHP | |
NY | 71M562 | Medicare ID - Type Unspecified | |
3186053 | Other | GHI BMP |