Healthcare Provider Details

I. General information

NPI: 1164221024
Provider Name (Legal Business Name): AMEENA ETWAROO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NORTHERN BLVD STE 19
GREAT NECK NY
11021-4802
US

IV. Provider business mailing address

475 NORTHERN BLVD STE 37
GREAT NECK NY
11021-4802
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-0030
  • Fax: 516-466-7723
Mailing address:
  • Phone: 516-829-0030
  • Fax: 516-466-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: