Provider Demographics
NPI:1477570802
Name:JAFARI-HASSAD, ROYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:JAFARI-HASSAD
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 1:85 LORDS WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1237
Mailing Address - Country:US
Mailing Address - Phone:516-829-2933
Mailing Address - Fax:516-487-5977
Practice Address - Street 1:1 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1150
Practice Address - Country:US
Practice Address - Phone:516-829-2933
Practice Address - Fax:516-487-5977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151499Medicaid
NY02151499Medicaid
NY019071Medicare ID - Type Unspecified