Provider Demographics
NPI:1396408183
Name:ABDELHAKIM, HANAN (REALTOR)
Entity Type:Individual
Prefix:
First Name:HANAN
Middle Name:
Last Name:ABDELHAKIM
Suffix:
Gender:F
Credentials:REALTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BROUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4006
Mailing Address - Country:US
Mailing Address - Phone:862-202-2915
Mailing Address - Fax:
Practice Address - Street 1:166 BROUGHTON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4006
Practice Address - Country:US
Practice Address - Phone:862-202-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA10173126651646172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7770001711315004Medicaid