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General NPI Number Information
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NPI Number | 1447717582
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Entity Type | Individual
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Provider Name | LEORA YOUSSEFZADEH PA-C, CDCES
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Gender | Female
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 555 TAXTER RD FL 3
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City | ELMSFORD
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State | NY
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Zip | 10523-2336
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Country | US
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Telephone | 914-457-4130
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Fax | 914-909-1461
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Provider Business Mailing Address
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Address Line | 122 SALEM RD
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-1591
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Country | US
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Telephone | 516-589-1089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 022912-1
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License Number State | NY
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