Provider Demographics
NPI:1588849707
Name:MEMON, HAFSA U (MD)
Entity type:Individual
Prefix:
First Name:HAFSA
Middle Name:U
Last Name:MEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3 TECHNOLOGY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4046
Mailing Address - Country:US
Mailing Address - Phone:631-273-3080
Mailing Address - Fax:631-435-7982
Practice Address - Street 1:3 TECHNOLOGY DR STE 100
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4046
Practice Address - Country:US
Practice Address - Phone:631-273-3080
Practice Address - Fax:631-435-7982
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52000207V00000X
TN51833207V00000X
NY287426207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
NY04780925Medicaid