MEDICARE: MOAMEN HASSAN

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	225100000X	Physical Therapist	055200	NY

General Provider Information

NPI Number	:	1255294104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOAMEN HASSAN

Provider Business Mailing Address
First Line	:	139 SAINT JOHNS AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3040
Country	:	US
Telephone Number	:	917-795-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	8727 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-1600
Country	:	US
Telephone Number	:	718-924-2122
Fax Number	:	718-924-2123

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ MOAMEN HASSAN ” Practice Location

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