Provider Demographics
NPI:1104828193
Name:EL SANDUBY, AMR A (MD)
Entity type:Individual
Prefix:DR
First Name:AMR
Middle Name:A
Last Name:EL SANDUBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMR
Other - Middle Name:A
Other - Last Name:SANDUBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3432 E TREMONT AVE FRNT 5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2033
Mailing Address - Country:US
Mailing Address - Phone:917-578-7376
Mailing Address - Fax:718-822-7400
Practice Address - Street 1:3432 E TREMONT AVE FRNT 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2033
Practice Address - Country:US
Practice Address - Phone:917-578-7376
Practice Address - Fax:718-822-7400
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219265207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105773Medicaid
NYA400007671Medicare PIN
NYA400007667Medicare PIN
NYA400007676Medicare PIN
NYA400007683Medicare PIN
NYA400007681Medicare PIN
NY5L5191Medicare PIN
NY02105773Medicaid
NYA400007688Medicare PIN
NYG400001260Medicare PIN
NYA400007655Medicare PIN