Provider Demographics
NPI:1487000618
Name:DRAME, AWA (PTA)
Entity Type:Individual
Prefix:
First Name:AWA
Middle Name:
Last Name:DRAME
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 WHISKEY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-8352
Mailing Address - Country:US
Mailing Address - Phone:631-821-8090
Mailing Address - Fax:631-821-8366
Practice Address - Street 1:679 WHISKEY ROAD
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961
Practice Address - Country:US
Practice Address - Phone:631-821-8090
Practice Address - Fax:631-821-8366
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006936-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1083884944Medicare UPIN