Provider Demographics
NPI:1306639117
Name:HASSAN, BASEM FAROUK SR (BCOM)
Entity type:Individual
Prefix:MR
First Name:BASEM
Middle Name:FAROUK
Last Name:HASSAN
Suffix:SR
Gender:M
Credentials:BCOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2001
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2001
Practice Address - Country:US
Practice Address - Phone:716-842-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168614926171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator