Healthcare Provider Details

I. General information

NPI: 1003130006
Provider Name (Legal Business Name): ANDREW JOSEPH YOUSSOUF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 35 STE 7
CLIFFWOOD NJ
07721-1515
US

IV. Provider business mailing address

800 JERSEY AVE
SPRING LAKE NJ
07762-1923
US

V. Phone/Fax

Practice location:
  • Phone: 732-566-2101
  • Fax:
Mailing address:
  • Phone: 732-616-5728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA09032000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number25MA09032000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD484989
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number4301513456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: