Provider Demographics
NPI:1770850323
Name:HADEN, GEORGINA (MD)
Entity Type:Individual
Prefix:MISS
First Name:GEORGINA
Middle Name:
Last Name:HADEN
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:EOLDA MEIR 20
Mailing Address - Street 2:APT 14
Mailing Address - City:HOLON
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:5845423
Mailing Address - Country:IL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 E 90TH ST APT 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4240
Practice Address - Country:US
Practice Address - Phone:646-434-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133139207R00000X
NY268439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003929OtherLICENSE