Healthcare Provider Details

I. General information

NPI: 1407490378
Provider Name (Legal Business Name): ASHWAG MOKBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CONVENT AVE
NEW YORK NY
10031-9101
US

IV. Provider business mailing address

77 BEACH ST
NEW YORK NEW YORK
10304
UM

V. Phone/Fax

Practice location:
  • Phone: 347-971-9947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: