Provider Demographics
NPI:1801435748
Name:GREENIDGE, HASSAN SHAHEED (PA)
Entity type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:SHAHEED
Last Name:GREENIDGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:577 FULTON AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4365
Mailing Address - Country:US
Mailing Address - Phone:516-670-6161
Mailing Address - Fax:
Practice Address - Street 1:577 FULTON AVE APT 2H
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4365
Practice Address - Country:US
Practice Address - Phone:516-670-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant