=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477637924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMIRA YASMIN WASEEM M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BUILDING 19 WEST ROAD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-222-0228
-----------------------------------------------------
Fax | 516-745-1519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 ELM LN
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-742-9663
-----------------------------------------------------
Fax | 516-742-9663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 220737
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------