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General NPI Number Information
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NPI Number | 1427481647
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE & REHAB
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 7685 103RD ST SUITE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32210-9325
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Country | US
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Telephone | 904-388-7964
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Fax | 904-388-7002
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Provider Business Mailing Address
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Address Line | 7685 103RD ST SUITE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32210-9325
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Country | US
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Telephone | 904-388-7964
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Fax | 904-388-7002
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Authorized Official
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Title or Position | PESIDENT
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Name | SYED SAJID HUSSAIN
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Credential | MD
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Telephone | 904-388-7964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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