Healthcare Provider Details

I. General information

NPI: 1780668889
Provider Name (Legal Business Name): NIVEEN HANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-3847
US

IV. Provider business mailing address

832 BRUNSWICK AVE
TRENTON NJ
08638-3847
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-2600
  • Fax: 609-396-3600
Mailing address:
  • Phone: 609-396-2600
  • Fax: 609-396-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA72230
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMA72230
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMA72230
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: