Healthcare Provider Details

I. General information

NPI: 1780648071
Provider Name (Legal Business Name): MICHAEL HANAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 AVENUE X 1ST FLOOR. MICHAEL HANAN MEDICAL P.C.
BROOKLYN NY
11235-2516
US

IV. Provider business mailing address

10325 68TH AVE APT 3-0
FOREST HILLS NY
11375-3267
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-0701
  • Fax: 718-975-0703
Mailing address:
  • Phone: 718-975-0701
  • Fax: 718-975-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number233117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: