Provider Demographics
NPI:1285093641
Name:ABOU EZZI, AMANDA CHRISTINA I (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CHRISTINA
Last Name:ABOU EZZI
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:CHRISTINA
Other - Last Name:ABOU EZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30 RIVER CT APT 2302
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 RIVER CT
Practice Address - Street 2:APT 2302
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310
Practice Address - Country:US
Practice Address - Phone:201-565-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program