Basic Information
| Provider Information | |||||||||
| NPI: | 1194770065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASSAN | ||||||||
| FirstName: | MOUSTAFA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154641800 | ||||||||
| FaxNumber: | 3154646252 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154641800 | ||||||||
| FaxNumber: | 3154646252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 243928 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | 243928 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 243928 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 08973733 | 05 | MS | MEDICAID | 51526800 | 01 | AL | BLUE CROSS | OTHER | 17-00359 | 01 | AL | UNITED HEALTH CARE | OTHER | 272003500 | 05 | FL | MEDICAID | 009983735 | 05 | AL | MEDICAID | 51526801 | 01 | AL | BLUE CROSS | OTHER | 009983745 | 05 | AL | MEDICAID | 02870955 | 05 | NY | MEDICAID |