Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA06977000 | NJ |
N | 207R00000X | Internist | 25MA06977000 | NJ |
N | 111NI0900X | Internist | 25MA06977000 | NJ |
Y | 207VG0400X | Gynecologist | 25MA06977000 | NJ |
N | 207VX0000X | Obstetrician | 25MA06977000 | NJ |
NPI | 1437197837 |
---|---|
Provider Name | Khaled A. Hassan |
First Address | Cresskill, NJ 07626-1705 |
Second Address | Clifton, NJ 07011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0082716 | (05) | NJ |
082716 | (05) | NJ |
G92141 | (02) |