MEDICARE: DR. SHAIKH NUSRAT HASAN 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	207Q00000X	Family Medicine Physician	208519	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5997765	OTHER	NY	GHI
3	7013015	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1225020860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAIKH NUSRAT HASAN MD

Provider Business Mailing Address
First Line	:	14 STRAWBERRY LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2518
Country	:	US
Telephone Number	:	917-498-8514
Fax Number	:	718-633-3134

Provider Business Practice Location Address
First Line	:	113 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3917
Country	:	US
Telephone Number	:	718-633-4677
Fax Number	:	718-633-3134

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/11/2015

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