Provider Demographics
NPI:1508055633
Name:HUSAIN, RIMA
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 LIBERTY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2245
Mailing Address - Country:US
Mailing Address - Phone:718-845-0200
Mailing Address - Fax:
Practice Address - Street 1:12401 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2245
Practice Address - Country:US
Practice Address - Phone:718-845-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039438OtherSTATE BOARD OF EDUCATION