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General NPI Number Information
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NPI Number | 1679013775
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Entity Type | Individual
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Provider Name | MARYAM QAYUMI-HUSSAIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 5036 JERICHO TPKE STE 307
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City | COMMACK
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State | NY
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Zip | 11725-2812
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Country | US
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Telephone | 631-486-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 22920 HILLSIDE AVE FL 2
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2627
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Country | US
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Telephone | 443-538-1658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 060713
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License Number State | NY
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