Healthcare Provider Details

I. General information

NPI: 1134170640
Provider Name (Legal Business Name): MUHAMMAD FAREED HASAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 ST. MARKS AVE, BKLYN NY 11238, 718638-8185 585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

2 THE DRAWBRIDGE
WOODBURY NY
11797-1000
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5401
  • Fax: 718-604-5527
Mailing address:
  • Phone: 718-638-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number182626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: