Provider Demographics
NPI:1821053232
Name:AL-SULLAMI, HUSSAIN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:HUSSAIN
Middle Name:
Last Name:AL-SULLAMI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EILEEN WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5301
Mailing Address - Country:US
Mailing Address - Phone:516-682-8560
Mailing Address - Fax:516-682-8562
Practice Address - Street 1:6851 JERICHO TPKE
Practice Address - Street 2:STE 235
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-682-8560
Practice Address - Fax:516-682-8562
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018804-1225100000X
NY018804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QP7761OtherBLUE CROSS
0947494OtherCIGNA
P2783358OtherOXFORD
NYQ27083Medicare ID - Type Unspecified