Provider Demographics
NPI:1346376522
Name:HASSAN, KHALID ALAMIN SR
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:ALAMIN
Last Name:HASSAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1898
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-1898
Mailing Address - Country:US
Mailing Address - Phone:201-863-7755
Mailing Address - Fax:201-863-9222
Practice Address - Street 1:1597 PATERSON PLANK RD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-4017
Practice Address - Country:US
Practice Address - Phone:973-517-5996
Practice Address - Fax:201-863-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHASS00252343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7763107Medicaid