Healthcare Provider Details

I. General information

NPI: 1154748804
Provider Name (Legal Business Name): MINA HEZAIN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 145TH ST
NEW YORK NY
10039-3142
US

IV. Provider business mailing address

7901 4TH AVE APT F12
BROOKLYN NY
11209-3919
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-3480
  • Fax: 212-281-3754
Mailing address:
  • Phone: 201-779-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03613500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number062739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: