Provider Demographics
NPI:1053941401
Name:HAMED, RAZAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RAZAN
Middle Name:
Last Name:HAMED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JULIA CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5108
Mailing Address - Country:US
Mailing Address - Phone:917-753-1130
Mailing Address - Fax:
Practice Address - Street 1:617 W 168TH ST RM 312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3925
Practice Address - Country:US
Practice Address - Phone:917-753-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020482225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH03476448356811OtherDMV DRIVER LICENSE