Healthcare Provider Details

I. General information

NPI: 1629636287
Provider Name (Legal Business Name): ISRAA HUSSEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 11/26/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WASHINGTON AVE
DUMONT NJ
07628-3066
US

IV. Provider business mailing address

125 WASHINGTON AVE
DUMONT NJ
07628-3066
US

V. Phone/Fax

Practice location:
  • Phone: 201-374-2722
  • Fax: 201-374-2723
Mailing address:
  • Phone: 201-374-2722
  • Fax: 201-374-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: