Provider Demographics
NPI:1255503876
Name:AMAL D. MARDINI, DC PLLC
Entity type:Organization
Organization Name:AMAL D. MARDINI, DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC PLLC
Authorized Official - Phone:716-817-6729
Mailing Address - Street 1:800 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1838
Mailing Address - Country:US
Mailing Address - Phone:716-817-6729
Mailing Address - Fax:716-817-9528
Practice Address - Street 1:8OO NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223
Practice Address - Country:US
Practice Address - Phone:716-817-6729
Practice Address - Fax:716-817-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008575-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty