Healthcare Provider Details

I. General information

NPI: 1477950087
Provider Name (Legal Business Name): AQSA ASIF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 37TH AVE
JACKSON HEIGHTS NY
11372-3922
US

IV. Provider business mailing address

11056 65TH AVE
FOREST HILLS NY
11375-1422
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-5600
  • Fax:
Mailing address:
  • Phone: 718-715-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: