Provider Demographics
NPI:1497191720
Name:ASHFAQ, AMNA
Entity Type:Individual
Prefix:
First Name:AMNA
Middle Name:
Last Name:ASHFAQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LINDA CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1735
Mailing Address - Country:US
Mailing Address - Phone:718-876-4932
Mailing Address - Fax:
Practice Address - Street 1:3630 HILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1503
Practice Address - Country:US
Practice Address - Phone:914-962-5572
Practice Address - Fax:914-962-5574
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006906213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty