Provider Demographics
NPI:1124031265
Name:AMADOR, FELICITAS G (MD)
Entity type:Individual
Prefix:DR
First Name:FELICITAS
Middle Name:G
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7401
Mailing Address - Country:US
Mailing Address - Phone:212-475-1900
Mailing Address - Fax:212-475-0901
Practice Address - Street 1:253 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7401
Practice Address - Country:US
Practice Address - Phone:212-475-1900
Practice Address - Fax:212-475-0901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RA0401X
NYXA5051610103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02080284Medicaid
NY02080284Medicaid