Provider Demographics
NPI:1225202070
Name:HUSSAR, MICHAEL G
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:HUSSAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DERWENT AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2133
Mailing Address - Country:US
Mailing Address - Phone:973-464-9135
Mailing Address - Fax:
Practice Address - Street 1:38 DERWENT AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2133
Practice Address - Country:US
Practice Address - Phone:973-464-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00424900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist