Healthcare Provider Details

I. General information

NPI: 1770919102
Provider Name (Legal Business Name): SAMINA HOQUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 04/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

1825 EASTCHESTER ROAD
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2400
  • Fax:
Mailing address:
  • Phone: 718-904-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: