Provider Demographics
NPI:1932133477
Name:HANAN, TIMUR (MD)
Entity type:Individual
Prefix:DR
First Name:TIMUR
Middle Name:
Last Name:HANAN
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 1:4 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2218
Mailing Address - Country:US
Mailing Address - Phone:917-538-7216
Mailing Address - Fax:
Practice Address - Street 1:234 149TH ST
Practice Address - Street 2:LINCOLN MEDICAL AND MENTAL HEALTH CENTER,
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-252-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238025208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04342WMedicare PIN