Healthcare Provider Details

I. General information

NPI: 1164449641
Provider Name (Legal Business Name): ABBAS M HUSAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W CHESTNUT AVE
MERCHANTVILLE NJ
08109
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-665-9424
  • Fax: 856-665-9426
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA32746
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: