Healthcare Provider Details

I. General information

NPI: 1801077508
Provider Name (Legal Business Name): HASSENNA AHMADI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST # 341
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

575 LEXINGTON AVE
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-7576
  • Fax: 212-746-8383
Mailing address:
  • Phone: 212-746-7576
  • Fax: 212-746-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number784232902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: