Provider Demographics
NPI:1730973249
Name:HASSUJI, IDRIS
Entity type:Individual
Prefix:
First Name:IDRIS
Middle Name:
Last Name:HASSUJI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W LOMBARD ST APT 706
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2534
Mailing Address - Country:US
Mailing Address - Phone:646-472-9896
Mailing Address - Fax:
Practice Address - Street 1:200 OLD COUNTRY RD STE 460
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4293
Practice Address - Country:US
Practice Address - Phone:516-663-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program