Provider Demographics
NPI:1659833945
Name:HOQUE-KHAN, REHANA YESMIN
Entity Type:Individual
Prefix:
First Name:REHANA
Middle Name:YESMIN
Last Name:HOQUE-KHAN
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 1:16020 85TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1720
Mailing Address - Country:US
Mailing Address - Phone:347-863-0140
Mailing Address - Fax:
Practice Address - Street 1:185 ELDRIGE STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1143
Practice Address - Country:US
Practice Address - Phone:347-863-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY092218Medicaid