Healthcare Provider Details

I. General information

NPI: 1649367699
Provider Name (Legal Business Name): ESSAM S YOUSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 COMMONWEALTH BLVD
BELLEROSE NY
11426-1839
US

IV. Provider business mailing address

7701 A 247 STREET QUEENS
BELLEROSE NY
11426
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-4535
  • Fax:
Mailing address:
  • Phone: 718-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number23865
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: