Provider Demographics
NPI:1083693279
Name:HUSAINY, TAHER (MD)
Entity Type:Individual
Prefix:DR
First Name:TAHER
Middle Name:
Last Name:HUSAINY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH STREET
Mailing Address - Street 2:STE E210
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-770-0808
Mailing Address - Fax:772-770-0260
Practice Address - Street 1:787 37TH STREET
Practice Address - Street 2:STE E210
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-770-0808
Practice Address - Fax:772-770-0260
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041139204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069782600Medicaid
FL4311627OtherAETNA
FL592458061001OtherCHAMPUS
FLME0041139OtherFLORIDA WORK COMP
FL130023529OtherRAILROAD MEDICARE
FL31144OtherBLUE CROSS
FL31144AMedicare ID - Type UnspecifiedMEDICARE
FL069782600Medicaid