Provider Demographics
NPI:1265630446
Name:HUSAIN, QUDSIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:QUDSIA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RIVER DR S
Mailing Address - Street 2:APT 2410
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1741
Mailing Address - Country:US
Mailing Address - Phone:571-723-9992
Mailing Address - Fax:
Practice Address - Street 1:45 RIVER DR S
Practice Address - Street 2:APT 2410
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1741
Practice Address - Country:US
Practice Address - Phone:571-723-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03208380Medicaid