Provider Demographics
NPI:1417143488
Name:HUSAIN, SYED IMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:IMAN
Last Name:HUSAIN
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 1:48 SUNSET RD S
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1149
Mailing Address - Country:US
Mailing Address - Phone:516-589-4812
Mailing Address - Fax:
Practice Address - Street 1:8740 165TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3500
Practice Address - Country:US
Practice Address - Phone:516-589-4812
Practice Address - Fax:718-280-3260
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274125207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03886679Medicaid
NY03886679Medicaid