Provider Demographics
NPI:1427019520
Name:HASAN, RUDABAH (MD)
Entity Type:Individual
Prefix:
First Name:RUDABAH
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1709
Mailing Address - Country:US
Mailing Address - Phone:914-636-5700
Mailing Address - Fax:917-210-6669
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-636-5700
Practice Address - Fax:917-210-6669
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237703207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150503Medicaid
NY237703OtherNEW YORK LICENSE NUMBER
NYH29645Medicare UPIN
NY000M51Medicare PIN