Healthcare Provider Details

I. General information

NPI: 1932362985
Provider Name (Legal Business Name): AMR ETMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 NORTHERN BLVD
FLUSHING NY
11358-2824
US

IV. Provider business mailing address

18901 NORTHERN BLVD
FLUSHING NY
11358-2824
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax: 646-878-6095
Mailing address:
  • Phone: 917-410-6905
  • Fax: 646-878-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8029A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101257200
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number275480-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: