Provider Demographics
NPI:1932259488
Name:HANSEN, WILLIAM M (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2814
Mailing Address - Country:US
Mailing Address - Phone:917-415-2116
Mailing Address - Fax:718-353-4107
Practice Address - Street 1:17003 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2709
Practice Address - Country:US
Practice Address - Phone:718-353-3668
Practice Address - Fax:718-353-4107
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004099213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971673Medicaid
NY00971673Medicaid
NY4283180001Medicare NSC
NY36828Medicare ID - Type Unspecified