Provider Demographics
NPI:1376169730
Name:HASAN, RASHEDUL (MD)
Entity Type:Individual
Prefix:
First Name:RASHEDUL
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6511 BOOTH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4184
Mailing Address - Country:US
Mailing Address - Phone:718-806-1434
Mailing Address - Fax:718-806-1435
Practice Address - Street 1:6135 DRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1528
Practice Address - Country:US
Practice Address - Phone:718-565-4200
Practice Address - Fax:718-446-8233
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYP105251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND18642DMedicaid