Provider Demographics
NPI:1780672188
Name:HUSSAIN, SAJJAD (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:SAJJAD
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14103 BAINBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1364 ROUTE 72 W
Practice Address - Street 2:SUITE 2
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2485
Practice Address - Country:US
Practice Address - Phone:609-597-3616
Practice Address - Fax:609-597-4557
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066885500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069779Medicaid
NJ0069779Medicaid
NJI32225Medicare UPIN