Provider Demographics
NPI:1194913681
Name:HUSSAIN, RUBABA (MD)
Entity type:Individual
Prefix:DR
First Name:RUBABA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3706 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2145
Mailing Address - Country:US
Mailing Address - Phone:718-530-0051
Mailing Address - Fax:347-269-5569
Practice Address - Street 1:100 COMMERCE PL
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1302
Practice Address - Country:US
Practice Address - Phone:732-499-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052139207Q00000X
NJ25MA09363800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ138770Medicare PIN
AZZ145098Medicare PIN