Healthcare Provider Details

I. General information

NPI: 1093650632
Provider Name (Legal Business Name): MR. YUSUF SALAHUDDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 72ND AVE
FOREST HILLS NY
11375-1035
US

IV. Provider business mailing address

55 W 100TH ST APT 7B
NEW YORK NY
10025-4845
US

V. Phone/Fax

Practice location:
  • Phone: 718-725-9894
  • Fax: 718-879-3107
Mailing address:
  • Phone: 347-449-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: