Healthcare Provider Details

I. General information

NPI: 1730614330
Provider Name (Legal Business Name): GYPSY LANE ENDOSCOPY SUITES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GYPSY LN
YOUNGSTOWN OH
44505-2170
US

IV. Provider business mailing address

1622 E MARKET ST
WARREN OH
44483-6613
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-9255
  • Fax: 330-743-9254
Mailing address:
  • Phone: 330-399-7215
  • Fax: 330-399-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEL YOUSSEF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-399-7215