Provider Demographics
NPI:1295539716
Name:HASAN, MD MEHEDI
Entity type:Individual
Prefix:
First Name:MD MEHEDI
Middle Name:
Last Name:HASAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 FROST LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1806
Mailing Address - Country:US
Mailing Address - Phone:516-862-1600
Mailing Address - Fax:
Practice Address - Street 1:15 SAINT PAULS PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2636
Practice Address - Country:US
Practice Address - Phone:516-466-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine