| Organization Name: | AMIDON MEDICAL GROUP PLLC |
| NPI Number: | 1053735886 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY D AMIDON (MANAGING MEMBER) |
| Mailing Address: | 2 Ellinwood Dr New Hartford |
| State: | NY US |
| Postal Code: | 134131102 |
| Phone Number: | 3155075081 |
| Fax Number: | 3157381663 |
| NPI Enumeration Date: | 02/14/2014 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 192498 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |