Provider Demographics
NPI:1124607288
Name:HASENZAHL, ANDREW JOHN (MPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:HASENZAHL
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HOFSTRA DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1923
Mailing Address - Country:US
Mailing Address - Phone:631-521-1986
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTHERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1220
Practice Address - Country:US
Practice Address - Phone:631-521-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program