Provider Demographics
NPI:1811286909
Name:KIDWAI, HASSAN JALIL (DO)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:JALIL
Last Name:KIDWAI
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Gender:M
Credentials:DO
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:DEPT. OF MEDICINE HSC T16
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-4000
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:DEPT. OF MEDICINE HSC T16
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-4000
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2022-01-07
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB09510700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine