Provider Demographics
NPI:1740377837
Name:HAJJAR, KATHERINE AMBERSON (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:AMBERSON
Last Name:HAJJAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 YORK AVENUE BOX #45
Mailing Address - Street 2:A-108
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4805
Mailing Address - Country:US
Mailing Address - Phone:212-746-2034
Mailing Address - Fax:212-746-8809
Practice Address - Street 1:1300 YORK AVENUE
Practice Address - Street 2:A-108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4805
Practice Address - Country:US
Practice Address - Phone:212-746-2034
Practice Address - Fax:212-746-8809
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2008-08-05
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-08-05
Provider Licenses
StateLicense IDTaxonomies
NY157869208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00864939Medicaid
NY34D79100Medicare ID - Type Unspecified
NYA62335Medicare UPIN