Basic Information
| Provider Information | |||||||||
| NPI: | 1831196971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMENDOLARA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LB# 7550 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191957550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 431 US HIGHWAY 22 E STE 79 | ||||||||
| Address2: | |||||||||
| City: | WHITEHOUSE STATION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088893427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085345559 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 03/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA05612100 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.