Basic Information
| Provider Information | |||||||||
| NPI: | 1043276918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSAIN | ||||||||
| FirstName: | ARIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 PINE TOP TRAIL | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102173284 | ||||||||
| FaxNumber: | 6104190350 | ||||||||
| Practice Location | |||||||||
| Address1: | 3505 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287578111 | ||||||||
| FaxNumber: | 9287571199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | MD046886L | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0805X | 54604 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260041671 | 01 | PA | RAIL ROAD | OTHER | 0015970290008 | 05 | PA | MEDICAID | 314995 | 05 | AZ | MEDICAID | 260045486 | 01 | PA | PALMETTO GBA | OTHER |