Provider Demographics
NPI:1023434065
Name:HUSAIN, MARYAM (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ORIOLE LN
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3530
Mailing Address - Country:US
Mailing Address - Phone:908-249-3390
Mailing Address - Fax:
Practice Address - Street 1:75 VERONICA AVE STE 205
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-246-9900
Practice Address - Fax:732-246-9903
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52050363AS0400X
NY017552363AS0400X
NJ25MP00326500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical