Provider Demographics
NPI:1184710030
Name:DGHEIM, HANNA (MD)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:DGHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OLD NYACK TURNPIKE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2453
Mailing Address - Country:US
Mailing Address - Phone:845-624-0626
Mailing Address - Fax:845-623-0855
Practice Address - Street 1:55 OLD NYACK TURNPIKE
Practice Address - Street 2:SUITE 505
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2453
Practice Address - Country:US
Practice Address - Phone:845-624-0626
Practice Address - Fax:845-623-0855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189605207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01641529Medicaid
NY01641529Medicaid
NY56J521Medicare ID - Type Unspecified