Provider Demographics
NPI:1669602975
Name:HASAN, OMAR S (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:S
Last Name:HASAN
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 1:500 E 77TH ST
Mailing Address - Street 2:APT 1239
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10162-0025
Mailing Address - Country:US
Mailing Address - Phone:718-795-8801
Mailing Address - Fax:
Practice Address - Street 1:216 ROUTE 17 NORTH STE 201
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3333
Practice Address - Country:US
Practice Address - Phone:201-845-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08616500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217743Medicaid
NJP00808725OtherRR MEDICARE
NJ171705YFDXMedicare PIN
NJP00808725OtherRR MEDICARE
NJ171705ZC8AMedicare PIN