Provider Demographics
NPI:1346246097
Name:HASAN, BASSAM I (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:I
Last Name:HASAN
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 1:2290 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2267
Mailing Address - Country:US
Mailing Address - Phone:732-942-4455
Mailing Address - Fax:732-942-4459
Practice Address - Street 1:2125 ROUTE 88 E
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3273
Practice Address - Country:US
Practice Address - Phone:732-892-4548
Practice Address - Fax:732-892-0961
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058494207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6404707Medicaid
NJF98977Medicare UPIN
NJ6404707Medicaid
NJ810301Medicare PIN