Provider Demographics
NPI:1720324510
Name:NOREEN, ASIFA (PA)
Entity type:Individual
Prefix:
First Name:ASIFA
Middle Name:
Last Name:NOREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PARK LANE DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1313
Mailing Address - Country:US
Mailing Address - Phone:646-384-8250
Mailing Address - Fax:
Practice Address - Street 1:795 CONEY ISLAND AVE
Practice Address - Street 2:SUITE P412
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5309
Practice Address - Country:US
Practice Address - Phone:646-239-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-24
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant