Provider Demographics
NPI:1366954091
Name:HANNA, AGHNATIOUS A HANNA AWADALLA (MD)
Entity type:Individual
Prefix:DR
First Name:AGHNATIOUS A HANNA
Middle Name:AWADALLA
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 1:316 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2625
Mailing Address - Country:US
Mailing Address - Phone:201-923-0454
Mailing Address - Fax:973-827-6636
Practice Address - Street 1:316 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2625
Practice Address - Country:US
Practice Address - Phone:201-923-0454
Practice Address - Fax:973-827-6636
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY426745207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-426-745-6OtherECFMG