Provider Demographics
NPI:1336231828
Name:HUSSAIN, MAHBOOB (MD,)
Entity Type:Individual
Prefix:DR
First Name:MAHBOOB
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:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-0659
Mailing Address - Country:US
Mailing Address - Phone:908-688-3727
Mailing Address - Fax:908-688-3036
Practice Address - Street 1:1201 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3307
Practice Address - Country:US
Practice Address - Phone:908-688-3727
Practice Address - Fax:908-688-3036
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06574400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06574400OtherNJ LICENSE CERTIFICATION
NJ7346204Medicaid
NJ63225Medicare UPIN
NJ7346204Medicaid