Healthcare Provider Details

I. General information

NPI: 1770543035
Provider Name (Legal Business Name): HIYAD JAWAD AL-HUSAINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PONDFIELD RD STE 11
BRONXVILLE NY
10708-4016
US

IV. Provider business mailing address

43 STRATTON RD
SCARSDALE NY
10583-7552
US

V. Phone/Fax

Practice location:
  • Phone: 914-776-0505
  • Fax: 914-274-8120
Mailing address:
  • Phone: 914-776-0505
  • Fax: 914-274-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number215433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: