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General NPI Number Information
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NPI Number | 1588448112
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Entity Type | Individual
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Provider Name | HANNA REBECCA ROAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 8002 KEW GARDENS RD STE 107
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City | KEW GARDENS
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State | NY
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Zip | 11415-3609
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Country | US
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Telephone | 718-459-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 21340 CHIRPING SPARROW RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3701
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 030456
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License Number State | NY
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