MEDICARE: GHONCHE HASHEMI

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	363LF0000X	Family Nurse Practitioner	339099	NY
2	363LF0000X	Family Nurse Practitioner	26NJ00512100	NJ

General Provider Information

NPI Number	:	1750780292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHONCHE HASHEMI

Provider Business Mailing Address
First Line	:	1 GUSTAVE L. LEVY PL, BOX 1134
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-241-8100
Fax Number	:	646-537-8921

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL, #1134
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-241-8100
Fax Number	:	646-537-8921

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	11/24/2014

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Directions to “ GHONCHE HASHEMI ” Practice Location

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