Healthcare Provider Details

I. General information

NPI: 1053406470
Provider Name (Legal Business Name): JAMAL HUSSAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 RT. 27 SUITE 4
KENDALL PARK NJ
08824-1600
US

IV. Provider business mailing address

3110 RT. 27 SUITE 4
KENDALL PARK NJ
08824-1600
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-4889
  • Fax: 732-940-8725
Mailing address:
  • Phone: 732-422-4889
  • Fax: 732-940-8725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA07581400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: