Basic Information
| Provider Information | |||||||||
| NPI: | 1164449641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSAIN | ||||||||
| FirstName: | ABBAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969200 | ||||||||
| FaxNumber: | 8563105603 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 W CHESTNUT AVE | ||||||||
| Address2: | |||||||||
| City: | MERCHANTVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566659424 | ||||||||
| FaxNumber: | 8566659426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA32746 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1837206 | 05 | NJ | MEDICAID |