Provider Demographics
NPI:1245614692
Name:HOSEIN, KEVIN JERREN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JERREN
Last Name:HOSEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22-18 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:201-475-5050
Mailing Address - Fax:
Practice Address - Street 1:22-18 BROADWAY STE 104
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-773-0887
Practice Address - Fax:201-797-8877
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10746700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease