Healthcare Provider Details

I. General information

NPI: 1982319315
Provider Name (Legal Business Name): AMAR LEE NABOULSI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 7TH AVE
NEW YORK NY
10019-6014
US

IV. Provider business mailing address

228 E 116TH ST APT 24
NEW YORK NY
10029-1436
US

V. Phone/Fax

Practice location:
  • Phone: 212-787-8315
  • Fax:
Mailing address:
  • Phone: 917-631-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number027490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: