MEDICARE: AMINATA DIENG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	018375	NY

General Provider Information

NPI Number	:	1881081784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINATA DIENG

Provider Business Mailing Address
First Line	:	141PARKHILL AVENUE APT 4W
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3402
Country	:	US
Telephone Number	:	347-596-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 PARKHILL AV APT 4W
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3402
Country	:	US
Telephone Number	:	347-596-0403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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