Healthcare Provider Details

I. General information

NPI: 1811297153
Provider Name (Legal Business Name): DANIEL STEVEN YOUSEFZADEH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 12/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 ROCKAWAY RD
LAKEWOOD NJ
08701-3931
US

IV. Provider business mailing address

1539 ROCKAWAY RD
LAKEWOOD NJ
08701-3931
US

V. Phone/Fax

Practice location:
  • Phone: 917-704-2367
  • Fax:
Mailing address:
  • Phone: 917-704-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4OQA01383200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4OQA01383200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: