Healthcare Provider Details

I. General information

NPI: 1780672188
Provider Name (Legal Business Name): SAJJAD HUSSAIN MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 ROUTE 72 W SUITE 2
MANAHAWKIN NJ
08050-2485
US

IV. Provider business mailing address

14103 BAINBRIDGE WAY
FREEHOLD NJ
07728-4877
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-3616
  • Fax: 609-597-4557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA066885500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: