Provider Demographics
NPI:1306992292
Name:IBRAHIM, HUSSEIN M (DSW)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:M
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 REVERE DR W
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001
Mailing Address - Country:US
Mailing Address - Phone:516-437-5557
Mailing Address - Fax:516-437-2435
Practice Address - Street 1:4 REVERE DR W
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001
Practice Address - Country:US
Practice Address - Phone:516-437-5557
Practice Address - Fax:516-437-2435
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01669611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN85331Medicare ID - Type Unspecified