Provider Demographics
NPI:1346228319
Name:HUSAIN, SYED AJMAL (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:AJMAL
Last Name:HUSAIN
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 1:7812 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2900
Mailing Address - Country:US
Mailing Address - Phone:718-326-2522
Mailing Address - Fax:718-894-8274
Practice Address - Street 1:7812 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2900
Practice Address - Country:US
Practice Address - Phone:718-326-2522
Practice Address - Fax:718-894-8274
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01686064Medicaid
NY207808OtherLICENSE #
NY02392AMedicare PIN
NY16N971Medicare ID - Type UnspecifiedMEDICARE BCBS
NY01686064Medicaid