Provider Demographics
NPI:1659448660
Name:HANNA, IMAN (MD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:HANNA
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 1:222 STATION PLZ N STE 620
Mailing Address - Street 2:WINTHROP UNIVERSITY HOSPITAL, DEPT OF PATHOLOGY
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3893
Mailing Address - Country:US
Mailing Address - Phone:516-663-2450
Mailing Address - Fax:516-663-4584
Practice Address - Street 1:222 STATION PLZ N STE 620
Practice Address - Street 2:WINTHROP UNIVERSITY HOSPITAL, DEPT OF PATHOLOGY
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-2450
Practice Address - Fax:516-663-4584
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07063900207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8409609Medicaid
NJ039043Medicare ID - Type Unspecified
NJG87864Medicare UPIN