Provider Demographics
NPI:1336465400
Name:TAWADROS, AYMAN EZZAT (RPH)
Entity Type:Individual
Prefix:MR
First Name:AYMAN
Middle Name:EZZAT
Last Name:TAWADROS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SUNFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1417
Mailing Address - Country:US
Mailing Address - Phone:718-499-4610
Mailing Address - Fax:718-499-4693
Practice Address - Street 1:291 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3679
Practice Address - Country:US
Practice Address - Phone:718-499-4610
Practice Address - Fax:718-499-4693
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02423063Medicaid