Healthcare Provider Details

I. General information

NPI: 1376128942
Provider Name (Legal Business Name): FAISAL HUSSNAIN MIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JOINT BASE MDL NJ
08641-5312
US

IV. Provider business mailing address

5951 NEWPORT ST
FORT DIX NJ
08640-5333
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102207793
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: