Provider Demographics
NPI:1386402089
Name:HASAN, MOHAMMAD KAMRUL
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KAMRUL
Last Name:HASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994A POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5106
Mailing Address - Country:US
Mailing Address - Phone:718-607-8951
Mailing Address - Fax:
Practice Address - Street 1:10 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1609
Practice Address - Country:US
Practice Address - Phone:914-699-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP126947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine