Healthcare Provider Details

I. General information

NPI: 1629242375
Provider Name (Legal Business Name): MAHMOUD S HUSSEIN BVSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 FORT PLAINS RD
HOWELL NJ
07731-1140
US

IV. Provider business mailing address

639 FORT PLAINS RD
HOWELL NJ
07731-1140
US

V. Phone/Fax

Practice location:
  • Phone: 732-577-0066
  • Fax: 732-577-0588
Mailing address:
  • Phone: 732-577-0066
  • Fax: 732-577-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number29VI00506300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: