Provider Demographics
NPI:1144594102
Name:MOUSTAFA, HANAN SAAD
Entity Type:Individual
Prefix:MRS
First Name:HANAN
Middle Name:SAAD
Last Name:MOUSTAFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4029
Mailing Address - Country:US
Mailing Address - Phone:917-322-9586
Mailing Address - Fax:718-979-0922
Practice Address - Street 1:345 VAN SICKLEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3830
Practice Address - Country:US
Practice Address - Phone:718-449-5050
Practice Address - Fax:718-449-3047
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027002-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist