Healthcare Provider Details

I. General information

NPI: 1619853173
Provider Name (Legal Business Name): AMPARO C HOARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

IV. Provider business mailing address

253E NORTH LAFAYETTE AVE 2F
EDISON NJ
08837
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1200
  • Fax:
Mailing address:
  • Phone: 310-567-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: