Provider Demographics
NPI:1124100185
Name:AMDUR, CATHYANNE (DC)
Entity type:Individual
Prefix:DR
First Name:CATHYANNE
Middle Name:
Last Name:AMDUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2804
Mailing Address - Country:US
Mailing Address - Phone:631-321-6300
Mailing Address - Fax:631-321-6338
Practice Address - Street 1:194 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2804
Practice Address - Country:US
Practice Address - Phone:631-321-6300
Practice Address - Fax:631-321-6338
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC07445-2OtherWORKERS COMPENSATION ID #
NYX62651Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
NYU28803Medicare UPIN
NYXDW901Medicare ID - Type UnspecifiedMEDICARE GROUP ID #