Provider Demographics
NPI:1053464917
Name:HASAN HAFEZ, ASHRAF (PT)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:HASAN HAFEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8845 19 AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:917-662-5776
Mailing Address - Fax:
Practice Address - Street 1:108-14 72 AVE FOURTH FLOOR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:718-261-7886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24R5Q6VR1Medicare PIN