Provider Demographics
NPI:1669868527
Name:HASSAN, MOHAMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BAY 17TH ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3706
Mailing Address - Country:US
Mailing Address - Phone:646-714-4915
Mailing Address - Fax:
Practice Address - Street 1:30 BAY 17TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3706
Practice Address - Country:US
Practice Address - Phone:646-714-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist