Provider Demographics
NPI:1295836633
Name:HOSSAIN, AKHTAR (MD)
Entity Type:Individual
Prefix:
First Name:AKHTAR
Middle Name:
Last Name:HOSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TOAD HILL RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-4370
Mailing Address - Country:US
Mailing Address - Phone:908-442-3570
Mailing Address - Fax:908-231-7722
Practice Address - Street 1:153 NORTH AUTEN AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-231-7700
Practice Address - Fax:908-231-7722
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077668002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI-27006Medicare UPIN
NJ089418Medicare ID - Type Unspecified