Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 505910 | NY |
NPI | 1225303654 |
---|---|
Provider Name | Ms. Safiyyah Aminah Abdul-Qawiyy |
First Address | Staten Island, NY 10304 |
Second Address | Staten Island, NY 10304-2224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 19/03/2012 |