Healthcare Provider Details

I. General information

NPI: 1306821095
Provider Name (Legal Business Name): KABEERUDDIN HASHMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WATERWORKS RD
FREEHOLD NJ
07728-4231
US

IV. Provider business mailing address

1 EDGEWATER ST
STATEN ISLAND NY
10305-4900
US

V. Phone/Fax

Practice location:
  • Phone: 732-866-3665
  • Fax: 732-866-3669
Mailing address:
  • Phone: 718-226-4324
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number191577
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number191577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: