Basic Information
| Provider Information | |||||||||
| NPI: | 1154416303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMABILE | ||||||||
| FirstName: | CHRISTENE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 DODGE RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168312700 | ||||||||
| FaxNumber: | 7168311818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 NIAGARA FALLS BLVD | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141508441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F331759-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 00026506101 | 01 | NY | UNIVERA | OTHER | 72652 | 01 | NY | GHI HMO | OTHER | 040426002554 | 01 | NY | FIDELIS | OTHER | 000560540002 | 01 | NY | BC/BS | OTHER | 9512009 | 01 | NY | INDEPENDENT HEALTH | OTHER |