Provider Demographics
NPI:1275123259
Name:HUSSEIN, TAYYAB (PA)
Entity Type:Individual
Prefix:
First Name:TAYYAB
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:TAYYAB
Other - Middle Name:
Other - Last Name:HUSSEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:255 MILL RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4759
Mailing Address - Country:US
Mailing Address - Phone:917-615-8905
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine