Healthcare Provider Details

I. General information

NPI: 1245619030
Provider Name (Legal Business Name): EHAB HASSANAIN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 85TH ST APT 2
BROOKLYN NY
11214-3148
US

IV. Provider business mailing address

1930 85TH STREET APT #2
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 917-459-0266
  • Fax: 631-422-7267
Mailing address:
  • Phone: 917-459-0266
  • Fax: 631-422-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number266145
License Number StateNY

VIII. Authorized Official

Name: MR. EHAB A HASSANAIN
Title or Position: ADMINISTARATOR
Credential: M.D
Phone: 917-459-0266