{
"Npi": {
"NPI": "1851057194",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "YOUSSEF",
"FirstName": "DEREK JAMES",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DVM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "YOUSSEF",
"OtherFirstName": "TAREK",
"OtherMiddleName": "OMAR",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DVM",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "502 VAN BUSSUM AVE APT 113",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SADDLE BROOK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07663-6171",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-810-0193",
"MailingAddressFaxNumber": "212-810-0194",
"FirstLinePracticeLocationAddress": "2143 ADAM CLAYTON POWELL JR BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10027-3008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-280-3700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/10/2021",
"LastUpdateDate": "08/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": "013636-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}