Healthcare Provider Details

I. General information

NPI: 1679673578
Provider Name (Legal Business Name): SAMEERA HUSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST VC15-207
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

PO BOX 29211
NEW YORK NY
10087-9211
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-2155
  • Fax: 212-927-9704
Mailing address:
  • Phone: 212-305-2155
  • Fax: 212-927-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number190589-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: