Provider Demographics
NPI:1669422820
Name:RANGWALA, HASNAIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:HASNAIN
Middle Name:
Last Name:RANGWALA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BARR HARBOR DR, SUITE 200
Mailing Address - Street 2:FOUR TOWER BRIDGE
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4979
Mailing Address - Country:US
Mailing Address - Phone:848-240-2812
Mailing Address - Fax:
Practice Address - Street 1:501 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5304
Practice Address - Country:US
Practice Address - Phone:800-337-6663
Practice Address - Fax:732-845-0804
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00076000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ320558OtherAMERICAID/AMERIGROUP
NJ9487224OtherAETNA PPO
NJ9420244OtherAETNA HMO
NJ3K3983OtherHEALTHNET
NJ519095ZURNMedicare PIN
NJ9487224OtherAETNA PPO
NJ9420244OtherAETNA HMO