Provider Demographics
NPI:1548591167
Name:MOHAMMAD S HUSSAIN MD PC
Entity Type:Organization
Organization Name:MOHAMMAD S HUSSAIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-347-0494
Mailing Address - Street 1:221 BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2780
Mailing Address - Country:US
Mailing Address - Phone:631-598-4897
Mailing Address - Fax:631-598-5866
Practice Address - Street 1:221 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2780
Practice Address - Country:US
Practice Address - Phone:631-598-4897
Practice Address - Fax:631-598-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596270Medicaid