Provider Demographics
NPI:1124216098
Name:HAWASLY, TAREK HAMMAMI (OD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:HAMMAMI
Last Name:HAWASLY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3221
Mailing Address - Country:US
Mailing Address - Phone:212-769-1410
Mailing Address - Fax:212-362-0456
Practice Address - Street 1:167 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3221
Practice Address - Country:US
Practice Address - Phone:212-769-1410
Practice Address - Fax:212-362-0456
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13300TPA152W00000X
NYTUV007638-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400045368Medicare PIN