Basic Information
| Provider Information | |||||||||
| NPI: | 1558359786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMNOTT | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COATES DR | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456511400 | ||||||||
| FaxNumber: | 8456511512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 STATE ROUTE 208 | ||||||||
| Address2: | STE 13 | ||||||||
| City: | MONROE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109504648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457836266 | ||||||||
| FaxNumber: | 8457839570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 245204 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 171100000X | A245204 | NY | N | Other Service Providers | Acupuncturist |
ID Information
| ID | Type | State | Issuer | Description | A400063017 | 01 | MEDICARE | OTHER |