Provider Demographics
NPI:1366594806
Name:HUSSAIN, JAMAL TARIQ (DPT)
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:TARIQ
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9571
Mailing Address - Country:US
Mailing Address - Phone:716-695-5393
Mailing Address - Fax:
Practice Address - Street 1:149 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1352
Practice Address - Country:US
Practice Address - Phone:716-465-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist