Healthcare Provider Details

I. General information

NPI: 1518528066
Provider Name (Legal Business Name): YASNA YUSUF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 E 149TH ST
BRONX NY
10455-1789
US

IV. Provider business mailing address

PO BOX 5036
WHITE PLAINS NY
10602-5036
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8700
  • Fax:
Mailing address:
  • Phone: 845-745-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number327845
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: