Provider Demographics
NPI:1750457032
Name:HASSAN, SYED S (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:S
Last Name:HASSAN
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 1:40 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1503
Mailing Address - Country:US
Mailing Address - Phone:516-626-0113
Mailing Address - Fax:
Practice Address - Street 1:739 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5336
Practice Address - Country:US
Practice Address - Phone:718-456-1900
Practice Address - Fax:718-456-8709
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01506981Medicaid
NY01506981Medicaid
NYF93064Medicare UPIN