Healthcare Provider Details

I. General information

NPI: 1487232633
Provider Name (Legal Business Name): HASSAN NAUSHAD JESSANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 4TH AVE
BROOKLYN NY
11217-2712
US

IV. Provider business mailing address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 718-438-5600
  • Fax:
Mailing address:
  • Phone: 484-476-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number342809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: