Healthcare Provider Details

I. General information

NPI: 1336316991
Provider Name (Legal Business Name): NARMIN FARAH HUSSAIN MIZAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NARMIN FARAH HUSSAIN M.D.

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579A CRANBURY RD 579A CRANBURY ROAD
EAST BRUNSWICK NJ
08816-5426
US

IV. Provider business mailing address

579A CRANBURY RD UNIVERSITY RADIOLOGY GROUP, PC
EAST BRUNSWICK NJ
08816-5426
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-0040
  • Fax: 732-390-1856
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-390-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number049629
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number265587
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA09158500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: