Provider Demographics
NPI:1750391041
Name:HANNA, AMIR ATALLAHA (MD)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:ATALLAHA
Last Name:HANNA
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:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657
Mailing Address - Country:US
Mailing Address - Phone:201-876-5550
Mailing Address - Fax:201-876-8995
Practice Address - Street 1:253 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-876-5550
Practice Address - Fax:201-876-8995
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA659382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7364709Medicaid
NJ7364709Medicaid
NJ001387Medicare ID - Type Unspecified