Healthcare Provider Details

I. General information

NPI: 1598621443
Provider Name (Legal Business Name): YASIR ABBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST STE 206
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

43 OAKMONT AVE
SELDEN NY
11784-3019
US

V. Phone/Fax

Practice location:
  • Phone: 631-307-9085
  • Fax:
Mailing address:
  • Phone: 631-565-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00860501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: