Provider Demographics
NPI:1326196346
Name:HANNA, GRETA G (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:G
Last Name:HANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WEST OVERLOOK
Mailing Address - Street 2:HARBORVIEW
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050
Mailing Address - Country:US
Mailing Address - Phone:516-933-6568
Mailing Address - Fax:516-933-6569
Practice Address - Street 1:15 W OVERLOOK
Practice Address - Street 2:HARBORVIEW
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4701
Practice Address - Country:US
Practice Address - Phone:516-933-6568
Practice Address - Fax:516-933-6569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25A301Medicare ID - Type UnspecifiedMEDICARE