Provider Demographics
NPI:1518569896
Name:GAMMAL, AMY EMILY (MSED)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:EMILY
Last Name:GAMMAL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4827
Mailing Address - Country:US
Mailing Address - Phone:917-609-6412
Mailing Address - Fax:
Practice Address - Street 1:2212 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4827
Practice Address - Country:US
Practice Address - Phone:917-609-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1373079191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist