Individual
AMENAH IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2190
(631) 686-2549
(631) 686-7651
Mailing address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2190
(631) 686-2549
(631) 686-7651
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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