Provider Demographics
NPI:1013492271
Name:HASSAN, ANUM (AUD)
Entity Type:Individual
Prefix:
First Name:ANUM
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 NEWARK AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-528-2690
Mailing Address - Fax:973-302-4074
Practice Address - Street 1:36 NEWARK AVENUE
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:973-528-2690
Practice Address - Fax:973-302-4074
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00151000231H00000X
NJ41YA00102200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0867454Medicaid
NJ0840289Medicaid