Provider Demographics
NPI:1619936200
Name:MIDANI, HANI (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:
Last Name:MIDANI
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 1:1528 COLUMBIA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033
Mailing Address - Country:US
Mailing Address - Phone:518-694-3053
Mailing Address - Fax:518-694-3056
Practice Address - Street 1:1528 COLUMBIA TURNPIKE
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-694-3053
Practice Address - Fax:518-694-3056
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214014-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954374Medicaid
NY01954374Medicaid
RB0781Medicare PIN
NYBB5753Medicare ID - Type Unspecified