Provider Demographics
NPI:1962388090
Name:AWAN, AMMAR (LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:AWAN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NEWTOWN AVE APT 6BW
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3066
Mailing Address - Country:US
Mailing Address - Phone:646-462-8474
Mailing Address - Fax:
Practice Address - Street 1:2330 NEWTOWN AVE APT 6BW
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3066
Practice Address - Country:US
Practice Address - Phone:646-462-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004966-012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer