Provider Demographics
NPI:1770894891
Name:HUSSAIN, TANVEER (BPHARM,BSC)
Entity type:Individual
Prefix:
First Name:TANVEER
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:BPHARM,BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5434
Mailing Address - Country:US
Mailing Address - Phone:347-425-8170
Mailing Address - Fax:917-651-2311
Practice Address - Street 1:5702 CLARENDON RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5434
Practice Address - Country:US
Practice Address - Phone:347-425-8170
Practice Address - Fax:917-651-2311
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01346592Medicaid