Provider Demographics
NPI:1760842942
Name:AMAKU, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AMAKU
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 1:237 W 35TH ST
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1905
Mailing Address - Country:US
Mailing Address - Phone:646-230-8190
Mailing Address - Fax:212-564-0917
Practice Address - Street 1:237 W 35TH ST
Practice Address - Street 2:SUITE 1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1905
Practice Address - Country:US
Practice Address - Phone:646-230-8190
Practice Address - Fax:212-564-0917
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator