Healthcare Provider Details

I. General information

NPI: 1255975231
Provider Name (Legal Business Name): MARY YOUSSEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

19 AMIRA LN
KINNELON NJ
07405-2958
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: