Healthcare Provider Details

I. General information

NPI: 1790043354
Provider Name (Legal Business Name): ALAA KAMIL ABDEL HAMEED HUSSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

27 ROLLING VIEWS DR
WOODLAND PARK NJ
07424-2641
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5329
  • Fax:
Mailing address:
  • Phone: 862-216-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MA10399200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: