Provider Demographics
NPI:1154095966
Name:EMANUEL, AMINA ROSALIE (NP)
Entity Type:Individual
Prefix:MS
First Name:AMINA
Middle Name:ROSALIE
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 E NEW YORK AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3882
Mailing Address - Country:US
Mailing Address - Phone:917-207-1384
Mailing Address - Fax:
Practice Address - Street 1:104 VERMILYEA AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3209
Practice Address - Country:US
Practice Address - Phone:212-544-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347378-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care