Provider Demographics
NPI:1598430324
Name:HUSSEIN, ABDILLAHI S
Entity type:Individual
Prefix:
First Name:ABDILLAHI
Middle Name:S
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1571
Mailing Address - Country:US
Mailing Address - Phone:413-291-9020
Mailing Address - Fax:857-302-4680
Practice Address - Street 1:191 CHESTNUT ST STE 2A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1512
Practice Address - Country:US
Practice Address - Phone:857-301-6890
Practice Address - Fax:857-302-4680
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS09467611343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)