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General NPI Number Information
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NPI Number | 1316971229
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Entity Type | Individual
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Provider Name | SAM HANNA P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 5910 JUNCTION BLVD
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City | ELMHURST
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State | NY
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Zip | 11373-5156
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Country | US
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Telephone | 917-545-9249
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Fax | 718-534-4135
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Provider Business Mailing Address
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Address Line | 1324 FOREST AVE SUITE 430
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2044
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Country | US
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Telephone | 718-618-0052
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Fax | 718-534-4135
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 025663
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License Number State | NY
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