Provider Demographics
NPI:1861045791
Name:HASSAN MEDICAL PAIN RELIEF AND WELLNESS CENTER
Entity Type:Organization
Organization Name:HASSAN MEDICAL PAIN RELIEF AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-244-8332
Mailing Address - Street 1:316 TENNENT RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1088
Mailing Address - Country:US
Mailing Address - Phone:917-244-8332
Mailing Address - Fax:732-587-5486
Practice Address - Street 1:200 PERRINE RD STE 209
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2836
Practice Address - Country:US
Practice Address - Phone:917-244-8332
Practice Address - Fax:732-587-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0598381Medicaid