Provider Demographics
NPI:1235125238
Name:AMADOR, SANDY (DPM)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3246
Mailing Address - Country:US
Mailing Address - Phone:201-662-8700
Mailing Address - Fax:201-453-8075
Practice Address - Street 1:6301 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3420
Practice Address - Country:US
Practice Address - Phone:201-662-8700
Practice Address - Fax:201-453-8075
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2015-05-06
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
NJMD02419213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7434405Medicaid
NJ4783090001Medicare NSC
NJ003386Medicare PIN
NJU68349Medicare UPIN