Provider Demographics
NPI:1235347311
Name:ELDEEB, YASSER (DPT)
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:ELDEEB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1707
Mailing Address - Country:US
Mailing Address - Phone:845-590-0279
Mailing Address - Fax:845-485-0020
Practice Address - Street 1:6212 CHERRY HILL DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1707
Practice Address - Country:US
Practice Address - Phone:845-590-0279
Practice Address - Fax:845-485-0020
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6698007OtherGHI
NY437171OtherMVP
NY83300OtherGHI HMO
NY6698007OtherGHI