Provider Demographics
NPI:1053402479
Name:HANNA, DALIA (MD)
Entity type:Individual
Prefix:DR
First Name:DALIA
Middle Name:
Last Name:HANNA
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 1:436 ROUTE 79 STE 11
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9783
Mailing Address - Country:US
Mailing Address - Phone:732-263-7970
Mailing Address - Fax:732-263-7971
Practice Address - Street 1:436 ROUTE 79 STE 11
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-9783
Practice Address - Country:US
Practice Address - Phone:732-263-7970
Practice Address - Fax:732-263-7971
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07951000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100692Medicaid
NJI51711Medicare UPIN
NJ100444WNCMedicare PIN
NJ116256Medicare PIN