Healthcare Provider Details

I. General information

NPI: 1962112284
Provider Name (Legal Business Name): HANIEH ROKNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/25/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235
US

IV. Provider business mailing address

2797 OCEAN PKWY
BROOKLYN NY
11235-7870
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: