Provider Demographics
NPI:1063715142
Name:GREGORY AMANTE DPM, PC
Entity type:Organization
Organization Name:GREGORY AMANTE DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-975-3440
Mailing Address - Street 1:2952 BRIGHTON 3RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7078
Mailing Address - Country:US
Mailing Address - Phone:718-975-4334
Mailing Address - Fax:
Practice Address - Street 1:2995 OCEAN PKWY APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8387
Practice Address - Country:US
Practice Address - Phone:718-975-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0055411213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty