Provider Demographics
NPI:1053406470
Name:HUSSAIN, JAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMAL
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 1:3110 RT. 27
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1600
Mailing Address - Country:US
Mailing Address - Phone:732-422-4889
Mailing Address - Fax:732-940-8725
Practice Address - Street 1:3110 RT. 27
Practice Address - Street 2:SUITE 4
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1600
Practice Address - Country:US
Practice Address - Phone:732-422-4889
Practice Address - Fax:732-940-8725
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07581400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002518Medicaid
NJH88064Medicare UPIN
NJ0002518Medicaid