Provider Demographics
NPI:1083800528
Name:CMM HASAN, PHYSICIAN
Entity Type:Organization
Organization Name:CMM HASAN, PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOELPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-724-8398
Mailing Address - Street 1:8405 169TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2033
Mailing Address - Country:US
Mailing Address - Phone:718-657-8001
Mailing Address - Fax:718-732-0783
Practice Address - Street 1:8405 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2033
Practice Address - Country:US
Practice Address - Phone:718-657-8001
Practice Address - Fax:718-732-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193570207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878124Medicaid
NY01878124Medicaid
G83311Medicare UPIN