Provider Demographics
NPI:1003900242
Name:HASHEM, BASSAM EMILE (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:EMILE
Last Name:HASHEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4724
Mailing Address - Country:US
Mailing Address - Phone:727-501-5729
Mailing Address - Fax:201-389-3619
Practice Address - Street 1:224 HAMBURG TPKE STE 4023
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:727-501-5729
Practice Address - Fax:201-389-3619
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70569207R00000X
NJ25MA08311600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine