Provider Demographics
NPI:1053761411
Name:HOSSAIN, MARUF (PA-C)
Entity type:Individual
Prefix:
First Name:MARUF
Middle Name:
Last Name:HOSSAIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8467 161ST ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1723
Mailing Address - Country:US
Mailing Address - Phone:347-345-8517
Mailing Address - Fax:
Practice Address - Street 1:193 W 237TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4141
Practice Address - Country:US
Practice Address - Phone:718-303-0479
Practice Address - Fax:718-303-0480
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant