Provider Demographics
NPI:1730365974
Name:CARMEN J. AMADIO JR
Entity type:Organization
Organization Name:CARMEN J. AMADIO JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMADIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPED, CPED, OST
Authorized Official - Phone:330-758-4011
Mailing Address - Street 1:170 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4855
Mailing Address - Country:US
Mailing Address - Phone:330-758-4011
Mailing Address - Fax:
Practice Address - Street 1:170 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4855
Practice Address - Country:US
Practice Address - Phone:330-758-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787390001Medicare NSC