Provider Demographics
NPI:1740300292
Name:HAKOUN, STUART
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:
Last Name:HAKOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STUART
Other - Middle Name:
Other - Last Name:HAKOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:421 SPROUT BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-7405
Mailing Address - Country:US
Mailing Address - Phone:845-736-4050
Mailing Address - Fax:
Practice Address - Street 1:421 SPROUT BROOK RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-7405
Practice Address - Country:US
Practice Address - Phone:845-736-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275260164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02523242Medicaid