Healthcare Provider Details

I. General information

NPI: 1972006245
Provider Name (Legal Business Name): MR. YUSUF ABDI HUSSEIN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CHATHAM GDNS APT B
ROCHESTER NY
14605-2022
US

IV. Provider business mailing address

308 CHATHAM GDNS APT B
ROCHESTER NY
14605-2022
US

V. Phone/Fax

Practice location:
  • Phone: 585-472-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number493342770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: