1356863088 NPI number — S M HASNAYEN MEDICAL OFFICE PLLC

Table of content: (NPI 1356863088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356863088 NPI number — S M HASNAYEN MEDICAL OFFICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S M HASNAYEN MEDICAL OFFICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356863088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 ROBBY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-395-6914
Provider Business Mailing Address Fax Number:
718-395-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8712 175TH ST # 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-5776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-395-6914
Provider Business Practice Location Address Fax Number:
718-395-1737
Provider Enumeration Date:
07/14/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CRDENTIALS COORDINATOR
Authorized Official Telephone Number:
646-283-2741

Provider Taxonomy Codes

  • Taxonomy code: 207LH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 258041 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03441412 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".