Healthcare Provider Details

I. General information

NPI: 1083819411
Provider Name (Legal Business Name): SYED ASIM HUSAIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 LAMBERTS LN
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

82 LAMBERTS LN
STATEN ISLAND NY
10314-7210
US

V. Phone/Fax

Practice location:
  • Phone: 718-477-5479
  • Fax: 718-761-1770
Mailing address:
  • Phone: 718-477-5479
  • Fax: 718-761-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number255539
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number255539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: