Healthcare Provider Details

I. General information

NPI: 1790073419
Provider Name (Legal Business Name): ALI HUSAIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 260A
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8756
  • Fax: 856-291-8750
Mailing address:
  • Phone: 856-291-8756
  • Fax: 856-291-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18432
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10090800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: