MEDICARE: HASEEBA ISMAIEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD479103	PA
2	2084P0800X	Psychiatry Physician	315223	NY

General Provider Information

NPI Number	:	1184128217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASEEBA ISMAIEL MD

Provider Business Mailing Address
First Line	:	14 EXETER WAY
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-2295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 CENTRE ST STE 824
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4558
Country	:	US
Telephone Number	:	732-443-7645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	10/07/2022

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