Healthcare Provider Details

I. General information

NPI: 1740124882
Provider Name (Legal Business Name): HARBOR PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750B 3RD AVE
BRONX NY
10456-2102
US

IV. Provider business mailing address

3750B 3RD AVE
BRONX NY
10456-2102
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-8057
  • Fax:
Mailing address:
  • Phone: 312-933-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RUBABA HUSSAIN
Title or Position: OWNER
Credential:
Phone: 312-933-8057