Provider Demographics
NPI:1225020860
Name:HASAN, SHAIKH NUSRAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIKH
Middle Name:NUSRAT
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2518
Mailing Address - Country:US
Mailing Address - Phone:917-498-8514
Mailing Address - Fax:718-633-3134
Practice Address - Street 1:113 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3917
Practice Address - Country:US
Practice Address - Phone:718-633-4677
Practice Address - Fax:718-633-3134
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY208519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01919002Medicaid
NY5997765OtherGHI
NY7013015OtherAETNA
NY5997765OtherGHI
NY01919002Medicaid