Provider Demographics
NPI:1972742716
Name:GHAZAL, BEENA (PA)
Entity Type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:
Last Name:GHAZAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 LINDEN BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4004
Mailing Address - Country:US
Mailing Address - Phone:516-285-7605
Mailing Address - Fax:
Practice Address - Street 1:1975 LINDEN BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4004
Practice Address - Country:US
Practice Address - Phone:516-285-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007705363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical