Provider Demographics
NPI:1154324226
Name:HASSEN, WALEED A (MD)
Entity Type:Individual
Prefix:
First Name:WALEED
Middle Name:A
Last Name:HASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:# 1272
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-241-4812
Mailing Address - Fax:212-987-4675
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:FL 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-4812
Practice Address - Fax:212-987-4675
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02520441Medicaid
NYI00324Medicare UPIN
NY02520441Medicaid