Provider Demographics
NPI:1376334938
Name:HASABALLA, MENNA RAAFAT (DO, MS)
Entity type:Individual
Prefix:DR
First Name:MENNA
Middle Name:RAAFAT
Last Name:HASABALLA
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:DR
Other - First Name:MENA
Other - Middle Name:RAAFAT
Other - Last Name:HASABALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, MS
Mailing Address - Street 1:2906 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6319
Mailing Address - Country:US
Mailing Address - Phone:551-697-4609
Mailing Address - Fax:
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-840-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program