Provider Demographics
NPI:1366821621
Name:HASAN, TAHSIN NAFIS (MD)
Entity Type:Individual
Prefix:
First Name:TAHSIN
Middle Name:NAFIS
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 1:101 NICOLLS RD # HSCT-10
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-848-6660
Mailing Address - Fax:
Practice Address - Street 1:PUTNAM HALL SOUTH CAMPUS
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-2412
Practice Address - Country:US
Practice Address - Phone:631-632-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3013762084B0040X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program