Provider Demographics
NPI:1194730671
Name:HASAN, JENNIFER (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAPLE STREAM RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2409
Mailing Address - Country:US
Mailing Address - Phone:609-448-1292
Mailing Address - Fax:609-448-3507
Practice Address - Street 1:113 MAPLE STREAM RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2409
Practice Address - Country:US
Practice Address - Phone:609-448-1292
Practice Address - Fax:609-448-3507
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00275300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071235ACDMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
NJU96223Medicare UPIN