Provider Demographics
NPI:1801576913
Name:ADA, NOURIDINE (STUDENT)
Entity type:Individual
Prefix:MR
First Name:NOURIDINE
Middle Name:
Last Name:ADA
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2600
Mailing Address - Country:US
Mailing Address - Phone:914-685-3131
Mailing Address - Fax:914-685-4131
Practice Address - Street 1:100 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2600
Practice Address - Country:US
Practice Address - Phone:914-685-3131
Practice Address - Fax:914-685-4131
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352783-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily