Healthcare Provider Details

I. General information

NPI: 1588156558
Provider Name (Legal Business Name): MUQDAD A HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF INTERNAL MEDICINE 1901, 1 ST AVENUE
NEW YORK NY
10029-7491
US

IV. Provider business mailing address

DEPARTMENT OF INTERNAL MEDICINE 1901, 1 ST AVENUE
NEW YORK NY
10029-7491
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax:
Mailing address:
  • Phone: 212-423-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: