Provider Demographics
NPI:1447884358
Name:ENNAB, NOOR (PA-C)
Entity type:Individual
Prefix:
First Name:NOOR
Middle Name:
Last Name:ENNAB
Suffix:
Gender:F
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 1:540 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4811
Mailing Address - Country:US
Mailing Address - Phone:917-636-8760
Mailing Address - Fax:
Practice Address - Street 1:510 HEMPSTEAD TPKE RM 203
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1152
Practice Address - Country:US
Practice Address - Phone:888-773-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant