Healthcare Provider Details

I. General information

NPI: 1447518741
Provider Name (Legal Business Name): HASAN MEMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ALEXANDER RD STE 208
PRINCETON NJ
08540-6331
US

IV. Provider business mailing address

707 ALEXANDER RD STE 208
PRINCETON NJ
08540-6331
US

V. Phone/Fax

Practice location:
  • Phone: 609-608-0653
  • Fax: 609-809-1518
Mailing address:
  • Phone: 609-608-0653
  • Fax: 609-809-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09888000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0013163
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17119
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number53640
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME180661
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberW5136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: