Provider Demographics
NPI:1013338995
Name:MCGOWAN, AMANDA ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ROSE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2255
Mailing Address - Country:US
Mailing Address - Phone:516-558-7858
Mailing Address - Fax:516-812-3975
Practice Address - Street 1:2710 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2255
Practice Address - Country:US
Practice Address - Phone:516-558-7858
Practice Address - Fax:516-812-3975
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant