Healthcare Provider Details

I. General information

NPI: 1790914760
Provider Name (Legal Business Name): AMEER HASSOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE # CG-35
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

451 CLARKSON AVE # CG-35
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4790
  • Fax:
Mailing address:
  • Phone: 718-245-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301094404
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301094404
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251498
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number251498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: