Provider Demographics
NPI:1396499828
Name:ARYA, HOOMAN (PA-C, MS)
Entity type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:ARYA
Suffix:
Gender:M
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2935
Mailing Address - Country:US
Mailing Address - Phone:516-548-3495
Mailing Address - Fax:
Practice Address - Street 1:5100 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2935
Practice Address - Country:US
Practice Address - Phone:516-548-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant