Provider Demographics
NPI:1780661009
Name:HASAN, CHOUDHURY MANJURUL (MD FACC, FCCP,FSACI)
Entity Type:Individual
Prefix:DR
First Name:CHOUDHURY
Middle Name:MANJURUL
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD FACC, FCCP,FSACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 169TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2033
Mailing Address - Country:US
Mailing Address - Phone:718-657-8001
Mailing Address - Fax:718-732-0783
Practice Address - Street 1:8405 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2033
Practice Address - Country:US
Practice Address - Phone:718-657-8001
Practice Address - Fax:718-732-0783
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193570207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878124Medicaid
NYG83311Medicare UPIN