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General NPI Number Information
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NPI Number | 1447884358
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Entity Type | Individual
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Provider Name | NOOR ENNAB PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/29/2020
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Last Update Date | 02/29/2020
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Provider Practice Location Address
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Address Line | 510 HEMPSTEAD TPKE RM 203
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-1152
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Country | US
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Telephone | 888-773-3936
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Fax |
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Provider Business Mailing Address
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Address Line | 540 85TH ST
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City | BROOKLYN
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State | NY
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Zip | 11209-4811
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Country | US
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Telephone | 917-636-8760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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