Basic Information
Provider Information
NPI: 1033419304
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANNA
FirstName: ASHRAF
MiddleName: SABRY
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2791 RICHMOND AVE
Address2:  
City: STATEN ISLAND
State: NY
PostalCode: 103145859
CountryCode: US
TelephoneNumber: 7188163710
FaxNumber: 7184202710
Practice Location
Address1: 1050 CLOVE RD
Address2:  
City: STATEN ISLAND
State: NY
PostalCode: 103013627
CountryCode: US
TelephoneNumber: 7188166440
FaxNumber: 7188163611
Other Information
ProviderEnumerationDate: 11/02/2010
LastUpdateDate: 11/02/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X259206NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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