Healthcare Provider Details

I. General information

NPI: 1619936200
Provider Name (Legal Business Name): HANI MIDANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 COLUMBIA TURNPIKE
CASTLETON NY
12033
US

IV. Provider business mailing address

1528 COLUMBIA TURNPIKE
CASTLETON NY
12033
US

V. Phone/Fax

Practice location:
  • Phone: 518-694-3053
  • Fax: 518-694-3056
Mailing address:
  • Phone: 518-694-3053
  • Fax: 518-694-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number214014-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: