Provider Demographics
NPI:1104929363
Name:DAVE, AMY U (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:U
Last Name:DAVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1602
Mailing Address - Country:US
Mailing Address - Phone:845-268-5905
Mailing Address - Fax:
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-969-1600
Practice Address - Fax:914-969-1685
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5579LIMedicare ID - Type Unspecified
NYQ25168Medicare UPIN