Healthcare Provider Details

I. General information

NPI: 1376006593
Provider Name (Legal Business Name): AMNA ANWAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 35TH ST
ASTORIA NY
11103-4701
US

IV. Provider business mailing address

4142 24TH ST APT 417
LONG ISLAND CITY NY
11101-3973
US

V. Phone/Fax

Practice location:
  • Phone: 718-278-1700
  • Fax:
Mailing address:
  • Phone: 347-213-0732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number062003-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: