Provider Demographics
NPI:1649502097
Name:NOOR, ASIF (RPH)
Entity type:Individual
Prefix:MR
First Name:ASIF
Middle Name:
Last Name:NOOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-417-0200
Mailing Address - Fax:718-417-4481
Practice Address - Street 1:339 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2726
Practice Address - Country:US
Practice Address - Phone:718-417-0200
Practice Address - Fax:718-417-4481
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041573OtherNYS LICENSE