Provider Demographics
NPI:1366070997
Name:AMJAD, ZUNAIR (PTA)
Entity type:Individual
Prefix:
First Name:ZUNAIR
Middle Name:
Last Name:AMJAD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 LISK AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1779
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:491 LISK AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1779
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5002
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011222225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant