Provider Demographics
NPI:1912527771
Name:PATWARY, AMENA
Entity Type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:PATWARY
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 1:20 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-8005
Mailing Address - Country:US
Mailing Address - Phone:212-675-3900
Mailing Address - Fax:
Practice Address - Street 1:4040 79TH ST APT B506
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1131
Practice Address - Country:US
Practice Address - Phone:646-841-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist