Healthcare Provider Details

I. General information

NPI: 1053941401
Provider Name (Legal Business Name): RAZAN HAMED PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 W 168TH ST RM 312
NEW YORK NY
10032-3925
US

IV. Provider business mailing address

25 JULIA CT
TOWNSHIP OF WASHINGTON NJ
07676-5108
US

V. Phone/Fax

Practice location:
  • Phone: 917-753-1130
  • Fax:
Mailing address:
  • Phone: 917-753-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number020482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: