Provider Demographics
NPI:1275667529
Name:HUSSEIN, AMTUL R (MD)
Entity Type:Individual
Prefix:
First Name:AMTUL
Middle Name:R
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6601
Mailing Address - Country:US
Mailing Address - Phone:212-397-7975
Mailing Address - Fax:
Practice Address - Street 1:15 HIGHWOOD PLACE
Practice Address - Street 2:BOX 1099
Practice Address - City:ALPINE
Practice Address - State:NJ
Practice Address - Zip Code:07620
Practice Address - Country:US
Practice Address - Phone:201-768-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41A461Medicare ID - Type Unspecified