Provider Demographics
NPI:1104664325
Name:AMISTOSO, ANDRE VILLEGAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:VILLEGAS
Last Name:AMISTOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 ROSA RD APT A13A
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-3723
Mailing Address - Country:US
Mailing Address - Phone:640-242-2545
Mailing Address - Fax:
Practice Address - Street 1:624 MCCLELLAN ST STE 101
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-347-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program