MEDICARE: MRS. IMAN TAHA ABDEL-HAFEZ

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	183500000X	Pharmacist	053213-1	NY

General Provider Information

NPI Number	:	1316279920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IMAN TAHA ABDEL-HAFEZ

Provider Business Mailing Address
First Line	:	7313 260TH ST
Second Line	:	APT 1
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1121
Country	:	US
Telephone Number	:	718-347-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-3328
Country	:	US
Telephone Number	:	212-956-0464
Fax Number	:

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

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	02/06/2010

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