Provider Demographics
NPI:1447370259
Name:HASAN, SYEDA I (MD)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:I
Last Name:HASAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 DUTCHESS TPKE STE 5G
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6444
Mailing Address - Country:US
Mailing Address - Phone:845-463-2896
Mailing Address - Fax:
Practice Address - Street 1:696 DUTCHESS TPKE STE 5G
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6444
Practice Address - Country:US
Practice Address - Phone:845-463-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT673442084P0800X
NJMA0638922084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7120401Medicaid
NJG40772Medicare UPIN
NJ7120401Medicaid