Healthcare Provider Details

I. General information

NPI: 1013553668
Provider Name (Legal Business Name): MINHAJUL HOQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 E 17TH ST
BROOKLYN NY
11235-3817
US

IV. Provider business mailing address

1753 E 12TH ST APT 6B
BROOKLYN NY
11229-1097
US

V. Phone/Fax

Practice location:
  • Phone: 347-875-4880
  • Fax:
Mailing address:
  • Phone: 347-686-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number780470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: