Provider Demographics
NPI:1164464962
Name:HASHMI, ANEESUDDIN SYED (MD, OD)
Entity Type:Individual
Prefix:
First Name:ANEESUDDIN
Middle Name:SYED
Last Name:HASHMI
Suffix:
Gender:M
Credentials:MD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 CARLTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-227-8810
Mailing Address - Fax:718-227-8810
Practice Address - Street 1:482 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4708
Practice Address - Country:US
Practice Address - Phone:917-514-8569
Practice Address - Fax:718-238-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08733200207R00000X
NYT006103152W00000X
PAMD440545207R00000X
NJOA05663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02010162Medicaid
NYC62491Medicare ID - Type Unspecified
NY02010162Medicaid