Provider Demographics
NPI:1790773968
Name:HASSANEIN CLINIC INC
Entity Type:Organization
Organization Name:HASSANEIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HASSANEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-692-8082
Mailing Address - Street 1:1607 NW FEDERAL HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9600
Mailing Address - Country:US
Mailing Address - Phone:772-692-8082
Mailing Address - Fax:772-232-9383
Practice Address - Street 1:1607 NW FEDERAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9600
Practice Address - Country:US
Practice Address - Phone:772-692-8082
Practice Address - Fax:772-232-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty