Provider Demographics
NPI:1124298005
Name:AMY J. DAVISON, D.O.,LLC
Entity type:Organization
Organization Name:AMY J. DAVISON, D.O.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-567-9977
Mailing Address - Street 1:197 COUNTY ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5022
Mailing Address - Country:US
Mailing Address - Phone:518-567-9977
Mailing Address - Fax:
Practice Address - Street 1:197 COUNTY ROUTE 10
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5022
Practice Address - Country:US
Practice Address - Phone:518-567-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2436112081N0008X, 208D00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I42042Medicare UPIN