Provider Demographics
NPI:1871589556
Name:HASHEMI, SEYED EBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:SEYED
Middle Name:EBRAHIM
Last Name:HASHEMI
Suffix:
Gender:M
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:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548
Mailing Address - Country:US
Mailing Address - Phone:718-859-7446
Mailing Address - Fax:718-859-3395
Practice Address - Street 1:1199 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-859-7446
Practice Address - Fax:718-859-3395
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122028208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00229438Medicaid
NY00229438Medicaid
C12431Medicare UPIN