Provider Demographics
NPI:1639101595
Name:HAFEEZ, MOHAMMAD (M D)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5006
Mailing Address - Country:US
Mailing Address - Phone:845-369-8671
Mailing Address - Fax:845-369-8673
Practice Address - Street 1:163 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5006
Practice Address - Country:US
Practice Address - Phone:845-369-8671
Practice Address - Fax:845-369-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine