Provider Demographics
NPI:1083790430
Name:FARES, HASSAN MOHAMED (NP)
Entity type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:MOHAMED
Last Name:FARES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4440
Mailing Address - Country:US
Mailing Address - Phone:716-903-4575
Mailing Address - Fax:
Practice Address - Street 1:3884 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1104
Practice Address - Country:US
Practice Address - Phone:716-681-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304167363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health