Basic Information
Provider Information | |||||||||
NPI: | 1093973109 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AMORES | ||||||||
FirstName: | EDWARD | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20 GRAND STREET, 3RD FL | ||||||||
Address2: |   | ||||||||
City: | WARWICK | ||||||||
State: | NY | ||||||||
PostalCode: | 109901035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8453685000 | ||||||||
FaxNumber: | 8459875979 | ||||||||
Practice Location | |||||||||
Address1: | 223 N VAN DIEN AVE | ||||||||
Address2: |   | ||||||||
City: | RIDGEWOOD | ||||||||
State: | NJ | ||||||||
PostalCode: | 074502726 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2014478000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/26/2008 | ||||||||
LastUpdateDate: | 12/02/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 60-239036 | NY | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 25MA08628800 | NJ | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207PS0010X | MD434444 | PA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
No ID Information.