Provider Demographics
NPI:1982211082
Name:HOSSAM ADHAM MEDICAL PC
Entity Type:Organization
Organization Name:HOSSAM ADHAM MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-885-5620
Mailing Address - Street 1:2165 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5035
Mailing Address - Country:US
Mailing Address - Phone:718-885-5620
Mailing Address - Fax:
Practice Address - Street 1:164 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4006
Practice Address - Country:US
Practice Address - Phone:718-885-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty