Provider Demographics
NPI:1922166677
Name:SULTANA, AMENA (MD)
Entity Type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GREENE AVENUE
Mailing Address - Street 2:SUITE # 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6433
Mailing Address - Country:US
Mailing Address - Phone:718-783-3690
Mailing Address - Fax:718-783-5584
Practice Address - Street 1:55 GREENE AVENUE
Practice Address - Street 2:SUITE # 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-783-3690
Practice Address - Fax:718-783-5584
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01657689Medicaid
550Y71OtherBCBS
P4789228OtherOXFORD
NY01657689Medicaid