Provider Demographics
NPI:1811956733
Name:AMORILLO, THOMAS P (MA, CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:AMORILLO
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Gender:M
Credentials:MA, CCC/SLP
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Mailing Address - Street 1:VAMC-NORTHPORT79 MIDDLEVILLE ROAD
Mailing Address - Street 2:79 MIDDLEVILEE ROAD ASPS-126
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2200
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-266-6709
Practice Address - Street 1:VAMC-NORTHPORT
Practice Address - Street 2:79 MIDDLEVILLE ROAD ASPS-126
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002046-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist