Basic Information
| Provider Information | |||||||||
| NPI: | 1164464962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASHMI | ||||||||
| FirstName: | ANEESUDDIN | ||||||||
| MiddleName: | SYED | ||||||||
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| Credential: | M.D., O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 571 CARLTON BLVD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182278810 | ||||||||
| FaxNumber: | 7182278810 | ||||||||
| Practice Location | |||||||||
| Address1: | 482 86TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112094708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175148569 | ||||||||
| FaxNumber: | 7182382148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08733200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 152W00000X | T006103 | NY | N | Eye and Vision Services Providers | Optometrist | 207R00000X | MD440545 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 152W00000X | OA05663 | NJ | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 02010162 | 05 | NY | MEDICAID |