Provider Demographics
NPI:1851364301
Name:HUSSAIN, AIJAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AIJAZ
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 APPLEGARTH RD
Mailing Address - Street 2:DEPARTMENT OF GERIATRICS
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3754
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:609-409-9493
Practice Address - Street 1:294 APPLEGARTH RD
Practice Address - Street 2:DEPARTMENT OF GERIATRICS
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3754
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:609-409-9493
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427358207R00000X
NJ25MA07821300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061727Medicaid
NJ089809Medicare PIN
I27520Medicare UPIN