Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 276862 | NY |
Y | 207RP1001X | Pulmonary Disease | 276862 | NY |
NPI | 1073883104 |
---|---|
Provider Name | Hussein Assallum |
First Address | Fort Lee, NJ 07024-2416 |
Second Address | New York, NY 10037-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2012 |
Last Update Date | 18/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073883104 | (05) | NY |