Provider Demographics
NPI:1255758116
Name:HANNA, JESSIE JALAL (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:JALAL
Last Name:HANNA
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 1:3 SKILES AVE # 223
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 SKILES AVENUE
Practice Address - Street 2:#223
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854
Practice Address - Country:US
Practice Address - Phone:212-659-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2916452084P0800X
NJ25MA101985002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry