Provider Demographics
NPI:1669143210
Name:KADDOUR, AMNEH (OD)
Entity type:Individual
Prefix:
First Name:AMNEH
Middle Name:
Last Name:KADDOUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMINEH
Other - Middle Name:
Other - Last Name:KADDOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:10225 67TH DR APT 5R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2877
Mailing Address - Country:US
Mailing Address - Phone:201-838-0575
Mailing Address - Fax:
Practice Address - Street 1:485 US 1
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009396152W00000X
NJ27OA00706800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist