Basic Information
| Provider Information | |||||||||
| NPI: | 1831406677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROHAN | ||||||||
| FirstName: | HANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 MEDICAL CENTER DR STE 212 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130666600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157441570 | ||||||||
| FaxNumber: | 3157441940 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 MEDICAL CENTER DR STE 212 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130666600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157441570 | ||||||||
| FaxNumber: | 3157441940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 268650 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 03875803 | 05 | NY | MEDICAID |