Provider Demographics
NPI:1568916344
Name:GHROUF, HUSEIN
Entity Type:Individual
Prefix:DR
First Name:HUSEIN
Middle Name:
Last Name:GHROUF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6656 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2531
Mailing Address - Country:US
Mailing Address - Phone:646-422-9793
Mailing Address - Fax:
Practice Address - Street 1:6656 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2531
Practice Address - Country:US
Practice Address - Phone:646-422-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55442183500000X
NY064063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist