Provider Demographics
NPI:1801812094
Name:HASSANEIN, MAHMOUD MOUSSA (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:MOUSSA
Last Name:HASSANEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 95TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6810
Mailing Address - Country:US
Mailing Address - Phone:718-748-4630
Mailing Address - Fax:718-240-6602
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:NEW YORK HOSPITAL OF QUEENS, DEPARTMENT OF PEDIATRICS.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1033
Practice Address - Fax:718-240-6602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2003362080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH53882Medicare UPIN