Healthcare Provider Details

I. General information

NPI: 1588368336
Provider Name (Legal Business Name): TINA HOSSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2154 NEWBRIDGE RD
BELLMORE NY
11710-2239
US

IV. Provider business mailing address

501 S WASHINGTON AVE
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 516-409-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: