Provider Demographics
NPI:1386770287
Name:AMSTERDAM MEMORIAL ENTERPRISE
Entity type:Organization
Organization Name:AMSTERDAM MEMORIAL ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DME DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCIALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:518-841-3785
Mailing Address - Street 1:5010 STATE HIGHWAY 30 SUITE 105
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-3785
Mailing Address - Fax:518-841-3673
Practice Address - Street 1:5010 STATE HIGHWAY 30 STE 105
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-841-3785
Practice Address - Fax:518-841-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01432457Medicaid
NY01432457Medicaid