Provider Demographics
NPI:1952667388
Name:ALFRED B. AMENDOLARA MD, PC
Entity Type:Organization
Organization Name:ALFRED B. AMENDOLARA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMENDOLARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-397-9313
Mailing Address - Street 1:4 BROADWAY CT
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-3430
Mailing Address - Country:US
Mailing Address - Phone:609-397-9313
Mailing Address - Fax:609-397-9364
Practice Address - Street 1:2380 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0199800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241300NJMedicaid
NJ439928Medicare PIN