Healthcare Provider Details

I. General information

NPI: 1184002511
Provider Name (Legal Business Name): NINA YOUSEFZADEH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JUNARD DR
ROSLYN NY
11576-2014
US

IV. Provider business mailing address

6 JUNARD DR
ROSLYN NY
11576-2014
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-4005
  • Fax:
Mailing address:
  • Phone: 516-428-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number048413
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number048413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: