Provider Demographics
NPI:1861559569
Name:HUSAINZAD, GHAZI AHMAD (DPM)
Entity type:Individual
Prefix:DR
First Name:GHAZI
Middle Name:AHMAD
Last Name:HUSAINZAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1948
Mailing Address - Country:US
Mailing Address - Phone:856-853-9191
Mailing Address - Fax:
Practice Address - Street 1:2 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2404
Practice Address - Country:US
Practice Address - Phone:856-853-9191
Practice Address - Fax:856-756-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005761213ES0103X
NJ25MD00293000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019629770001Medicaid
NJ114407Medicare PIN
PA1019629770001Medicaid
NJ5965760003Medicare NSC