Provider Demographics
NPI:1649592387
Name:MCGOWAN, AMANDA A (LAC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:A
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19 E 95TH ST
Mailing Address - Street 2:APT 4R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0710
Mailing Address - Country:US
Mailing Address - Phone:212-427-2097
Mailing Address - Fax:
Practice Address - Street 1:49 E 78TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0211
Practice Address - Country:US
Practice Address - Phone:917-863-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist