=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730160664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA ANN HAHN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 585 BROADWAY
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-792-1234
-----------------------------------------------------
Fax | 516-797-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 585 BROADWAY
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-792-1234
-----------------------------------------------------
Fax | 516-797-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 005027
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------