Healthcare Provider Details

I. General information

NPI: 1437197837
Provider Name (Legal Business Name): KHALED A. HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN AVENUE
CLIFTON NJ
07011
US

IV. Provider business mailing address

71 HOOVER DRIVE
CRESSKILL NJ
07626-1705
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-6900
  • Fax:
Mailing address:
  • Phone: 201-248-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06977000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA06977000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA06977000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06977000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: