Provider Demographics
NPI:1457446817
Name:HANNA, RAFIK (MD)
Entity Type:Individual
Prefix:
First Name:RAFIK
Middle Name:
Last Name:HANNA
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 1:1111 AMSTERDAM AVENUE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-523-3981
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVENUE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-523-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08858500207P00000X
NY229629207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00184239OtherRAILROAD MED
MD75859903OtherBLUE SHIELD
MD406337600Medicaid
MD75859903OtherBLUE SHIELD