Provider Demographics
NPI:1376061598
Name:HOQUE, SADIAH MUNMUN (DPM)
Entity Type:Individual
Prefix:
First Name:SADIAH
Middle Name:MUNMUN
Last Name:HOQUE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KINGS HWY APT 204
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-1022
Mailing Address - Country:US
Mailing Address - Phone:516-784-7830
Mailing Address - Fax:
Practice Address - Street 1:5735 RIDGE AVE STE 208
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1747
Practice Address - Country:US
Practice Address - Phone:215-487-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006880213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006880OtherDPM COMMONWEALTH OF PA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATION