Provider Demographics
NPI:1306124482
Name:KAMEL, HANAN WADID
Entity type:Individual
Prefix:DR
First Name:HANAN
Middle Name:WADID
Last Name:KAMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BRAISTED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 BRAISTED AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6134
Practice Address - Country:US
Practice Address - Phone:347-873-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03211500183500000X
FLPS47392183500000X
NY7581385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist