Provider Demographics
NPI:1326104662
Name:HEGAZI, TAREK (MD)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:HEGAZI
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 1:514 AVENUE M
Mailing Address - Street 2:1 A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4648
Mailing Address - Country:US
Mailing Address - Phone:718-339-5749
Mailing Address - Fax:718-339-5754
Practice Address - Street 1:514 AVENUE M
Practice Address - Street 2:1 A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4648
Practice Address - Country:US
Practice Address - Phone:718-339-5749
Practice Address - Fax:718-339-5754
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01582778Medicaid
670421Medicare ID - Type Unspecified
NY01582778Medicaid