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General NPI Number Information
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NPI Number | 1831984855
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Entity Type | Individual
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Provider Name | AMNUAY GOODDAY PETTWAY MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 374 STOCKHOLM ST
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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Country | US
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Telephone | 718-963-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PLEASANT ST
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City | RUMFORD
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State | RI
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Zip | 02916-1311
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Country | US
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Telephone | 414-340-9665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 1108467
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P132374
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License Number State | NY
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