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General NPI Number Information
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NPI Number | 1619266301
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Entity Type | Organization
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Legal Business Name | IDEAL FIRST ASSISTANTS LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 174 MAPES AVE FL 3
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City | NEWARK
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State | NJ
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Zip | 07112-2018
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Country | US
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Telephone | 347-653-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 174 MAPES AVE FL 3
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City | NEWARK
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State | NJ
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Zip | 07112-2018
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Country | US
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Telephone | 347-653-8920
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ENAMUL HOQUE
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Credential |
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Telephone | 347-653-8920
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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 |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00145100
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License Number State | NJ
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