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NPI Code Detail

MEDICARE: MS. JAHANARA ROUF PA

MEDICARE: MS. JAHANARA ROUF PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPX12-00748NJ

General Provider Information

NPI Number : 1376802322
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JAHANARA ROUF PA
Provider Business Mailing Address
First Line : 2420 DITMARS BLVD
Second Line :
City : ASTORIA
State : NY
Zip : 11105-3348
Country : US
Telephone Number : 347-339-0085
Fax Number :
Provider Business Practice Location Address
First Line : 362 MONROE ST
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-4114
Country : US
Telephone Number : 347-339-0085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2012
Last Update Date : 05/11/2012

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Directions to “ MS. JAHANARA ROUF PA” Practice Location

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