Healthcare Provider Details

I. General information

NPI: 1629301916
Provider Name (Legal Business Name): GETAW WORKU HASSEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

40 W 116TH ST APT B509
NEW YORK NY
10026-2867
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6464
  • Fax: 212-423-8848
Mailing address:
  • Phone: 347-564-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number254886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: