Provider Demographics
NPI:1992146138
Name:MUNAWAR, GHAZALA MAHMOOD (PA)
Entity type:Individual
Prefix:
First Name:GHAZALA
Middle Name:MAHMOOD
Last Name:MUNAWAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1001
Mailing Address - Country:US
Mailing Address - Phone:646-238-0259
Mailing Address - Fax:
Practice Address - Street 1:1121 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2340
Practice Address - Country:US
Practice Address - Phone:718-434-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant