Provider Demographics
NPI:1467444968
Name:HANNA, GAMAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GAMAL
Middle Name:K
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 1:79 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307
Mailing Address - Country:US
Mailing Address - Phone:201-653-3880
Mailing Address - Fax:
Practice Address - Street 1:79 NELSON AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4006
Practice Address - Country:US
Practice Address - Phone:201-653-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05217700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1884808Medicaid
NJ622044Medicare ID - Type Unspecified
NJ622044UWXMedicare PIN
NJ622044UWYMedicare PIN
NJ1884808Medicaid
NJ622044UXLMedicare PIN
NJ183806UWXMedicare PIN