Provider Demographics
NPI:1104223569
Name:S. HASAN PHYSICIAN PC
Entity Type:Organization
Organization Name:S. HASAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAIKH
Authorized Official - Middle Name:N
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-498-8514
Mailing Address - Street 1:14 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2518
Mailing Address - Country:US
Mailing Address - Phone:917-498-8514
Mailing Address - Fax:718-633-3134
Practice Address - Street 1:113 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3917
Practice Address - Country:US
Practice Address - Phone:718-633-4677
Practice Address - Fax:718-633-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208519261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01919002Medicaid