Provider Demographics
NPI:1215968540
Name:HANNA, MONEER K (MD)
Entity type:Individual
Prefix:DR
First Name:MONEER
Middle Name:K
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 KINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6908
Mailing Address - Country:US
Mailing Address - Phone:201-974-8824
Mailing Address - Fax:
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-466-6950
Practice Address - Fax:516-466-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36841208800000X
NY129247208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60219400Medicaid
NY129247OtherLICENSE
NJ36841OtherLICENSE
NJ36841OtherLICENSE
NJC08177Medicare UPIN