Provider Demographics
NPI:1922001841
Name:HASSMAN, DAVID R (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HASSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CROSS KEYS RD # 300 A
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9263
Mailing Address - Country:US
Mailing Address - Phone:856-767-0077
Mailing Address - Fax:856-767-6102
Practice Address - Street 1:175 CROSS KEYS RD # 300 A
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05814600207Q00000X
NJMB58146207QG0300X, 207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084318OtherMEDICARE
NJ084318OtherMEDICARE
NJHA084318Medicare ID - Type UnspecifiedMEDICARE #