Provider Demographics
NPI:1659731990
Name:MONWARA HASSAN MD PA
Entity Type:Organization
Organization Name:MONWARA HASSAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONWARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-373-8198
Mailing Address - Street 1:2721 SE NORTH LOOKOUT BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6108
Mailing Address - Country:US
Mailing Address - Phone:914-373-8198
Mailing Address - Fax:
Practice Address - Street 1:2500 RHODE ISLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4771
Practice Address - Country:US
Practice Address - Phone:772-489-4001
Practice Address - Fax:772-489-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1191462081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ427YMedicare PIN