Provider Demographics
NPI:1295762466
Name:HASBUN, WILLIAM M (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:HASBUN
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 1:2055 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-7575
Mailing Address - Country:US
Mailing Address - Phone:856-577-6627
Mailing Address - Fax:239-304-9805
Practice Address - Street 1:5068 ANNUNCIATION CIR UNIT 111
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9668
Practice Address - Country:US
Practice Address - Phone:239-867-4395
Practice Address - Fax:239-217-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05605800207QG0300X, 207R00000X
FLME154619207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5209307Medicaid
688969Medicare ID - Type Unspecified
NJ5209307Medicaid