Provider Demographics
NPI:1437221207
Name:AMIN, HOSSAM HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:HASSAN
Last Name:AMIN
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 1:6903 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1509
Mailing Address - Country:US
Mailing Address - Phone:718-238-6161
Mailing Address - Fax:718-238-6194
Practice Address - Street 1:6903 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1501
Practice Address - Country:US
Practice Address - Phone:718-238-6161
Practice Address - Fax:718-238-6194
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204538207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG46979Medicare UPIN