Provider Demographics
NPI:1073035309
Name:GARDEN STATE RHEUMATOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:GARDEN STATE RHEUMATOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-370-7717
Mailing Address - Street 1:101 PROSPECT STREET
Mailing Address - Street 2:SUITE 216
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-370-7717
Mailing Address - Fax:732-370-6519
Practice Address - Street 1:101 PROSPECT ST STE 216
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5003
Practice Address - Country:US
Practice Address - Phone:732-370-7717
Practice Address - Fax:732-370-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty