Provider Demographics
NPI:1093972671
Name:MEMBERS, HANI (RPA-C)
Entity Type:Individual
Prefix:
First Name:HANI
Middle Name:
Last Name:MEMBERS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1728
Mailing Address - Country:US
Mailing Address - Phone:631-608-8384
Mailing Address - Fax:
Practice Address - Street 1:50 COOPER SQ # B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7108
Practice Address - Country:US
Practice Address - Phone:212-677-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012286-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical