David Amram, D.M.D
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Medford, NY
NPI 1962536409 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962536409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 048240 (NY)
- Practice address
- 1645 Route 112 Ste B
Medford, NY 11763-3635 - Phone
- (631) 289-0909
- Fax
- (631) 289-0918
- NPI assigned
- Mar 15, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048240 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 048240 | NY | Yes |
Addresses
Primary practice location
1645 Route 112 Ste B
Medford, NY 11763-3635
Mailing address
1645 Route 112 Ste B
Medford, NY 11763-3635
Phone (631) 289-0909
NPI Registry JSON
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962536409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1645 ROUTE 112 STE B",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117633635",
"telephone_number": "631-289-0909",
"fax_number": "631-289-0918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1645 ROUTE 112 STE B",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117633635",
"telephone_number": "631-289-0909",
"fax_number": "631-289-0918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMRAM",
"first_name": "DAVID",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "048240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
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- Elizabeth G Alexis
- All Clean Cleaning and Maintenance
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- Kerry Anderson
- Breanna Andrews
- Angela J Bailey & Associates, Inc
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All providers in Medford, NY · Orthodontics and Dentofacial Orthopedics Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.