MEDICARE: GARDEN STATE RHEUMATOLOGY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1073035309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN STATE RHEUMATOLOGY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	101 PROSPECT STREET
Second Line	:	SUITE 216
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701
Country	:	US
Telephone Number	:	732-370-7717
Fax Number	:	732-370-6519

Provider Business Practice Location Address
First Line	:	101 PROSPECT ST STE 216
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5003
Country	:	US
Telephone Number	:	732-370-7717
Fax Number	:	732-370-6519

Authorized Official
Title or Position	:	CEO
Name	:	SHAHZAD HUSSAIN
Credential	:	M.D
Telephone Number	:	732-370-7717

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/21/2022

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