Provider Demographics
NPI:1700294303
Name:HASHEMI-AWWAL, ANISSA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:
Last Name:HASHEMI-AWWAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 US HIGHWAY 46 STE B12
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1656
Mailing Address - Country:US
Mailing Address - Phone:973-265-0888
Mailing Address - Fax:
Practice Address - Street 1:115 US HIGHWAY 46 STE B12
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1656
Practice Address - Country:US
Practice Address - Phone:973-265-0888
Practice Address - Fax:973-315-5363
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00340700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery