Healthcare Provider Details

I. General information

NPI: 1902057714
Provider Name (Legal Business Name): SYEDA I HASAN, M.D.P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BEECHWOOD RD STE 4
SUMMIT NJ
07901-2532
US

IV. Provider business mailing address

28 BEECHWOOD RD STE 4
SUMMIT NJ
07901-2532
US

V. Phone/Fax

Practice location:
  • Phone: 908-608-1414
  • Fax: 908-608-9441
Mailing address:
  • Phone: 908-608-1414
  • Fax: 908-608-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA06389200
License Number StateNJ

VIII. Authorized Official

Name: DR. SYEDA I HASAN
Title or Position: M.D.
Credential:
Phone: 908-608-1414