Provider Demographics
NPI:1780241216
Name:HAJJAR, MARK (MS, CGC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAJJAR
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PARK ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2021
Mailing Address - Country:US
Mailing Address - Phone:857-719-6619
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:AWI - MINER 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:719-780-7315
Practice Address - Fax:718-780-5756
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS