Basic Information
| Provider Information | |||||||||
| NPI: | 1841385424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMATO | ||||||||
| FirstName: | INDIRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PL | ||||||||
| Address2: | MEB 308 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357883 | ||||||||
| FaxNumber: | 7322356609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ROBERT WOOD JOHNSON PL | ||||||||
| Address2: | MEB 308 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357883 | ||||||||
| FaxNumber: | 7322356609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA07729400 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | MA07729400 | 01 | NJ | STATE LICENSE | OTHER | 0059552 | 05 | NJ | MEDICAID |