Provider Demographics
NPI:1356631550
Name:HANOMAN, BABITA (R-PAC)
Entity Type:Individual
Prefix:MRS
First Name:BABITA
Middle Name:
Last Name:HANOMAN
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 182ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2337
Mailing Address - Country:US
Mailing Address - Phone:718-350-4286
Mailing Address - Fax:
Practice Address - Street 1:19503 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2014
Practice Address - Country:US
Practice Address - Phone:718-465-3002
Practice Address - Fax:718-465-3115
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant