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NPI Code Detail

MEDICARE: MRS. ADIJA MEMBOUP PA

MEDICARE: MRS. ADIJA MEMBOUP 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 Assistant5545CT
2363A00000XPhysician Assistant008489NY

General Provider Information

NPI Number : 1942365986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADIJA MEMBOUP PA
Provider Business Mailing Address
First Line : 24 HOSPITAL AVE
Second Line :
City : DANBURY
State : CT
Zip : 06810-6077
Country : US
Telephone Number : 917-873-5185
Fax Number :
Provider Business Practice Location Address
First Line : 24 HOSPITAL AVE
Second Line :
City : DANBURY
State : CT
Zip : 06810-6077
Country : US
Telephone Number : 917-873-5185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 05/07/2022

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