=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629301916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GETAW WORKU HASSEN MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2009
-----------------------------------------------------
Last Update Date | 08/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 1ST AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-7404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-423-6464
-----------------------------------------------------
Fax | 212-423-8848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 W 116TH ST APT B509
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-564-6488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 254886
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------