Individual
HASAN SHABAZZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1441 OLD NORTHERN BLVD, ROSLYN, NY 11576
(917) 832-5180
Mailing address
74 JACKSON RD, VALLEY STREAM, NY 11581-2126
(917) 832-5180
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
NY
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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