Provider Demographics
NPI:1093371601
Name:SUBA, JOHURA RASHID
Entity Type:Individual
Prefix:
First Name:JOHURA
Middle Name:RASHID
Last Name:SUBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1122
Mailing Address - Country:US
Mailing Address - Phone:347-624-3515
Mailing Address - Fax:
Practice Address - Street 1:7808 97TH AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1122
Practice Address - Country:US
Practice Address - Phone:347-624-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY768078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse