Provider Demographics
NPI:1104645134
Name:LADHANI JAIN, MAHI-RUHI (PA-C)
Entity type:Individual
Prefix:
First Name:MAHI-RUHI
Middle Name:
Last Name:LADHANI JAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAHI
Other - Middle Name:
Other - Last Name:LADHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:35 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1819
Mailing Address - Country:US
Mailing Address - Phone:516-444-0388
Mailing Address - Fax:
Practice Address - Street 1:270-5 76TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant