Provider Demographics
NPI:1598023426
Name:YOUSSEF, ELLEN R (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GLEASON BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7764
Mailing Address - Country:US
Mailing Address - Phone:845-635-8285
Mailing Address - Fax:
Practice Address - Street 1:29 GLEASON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7764
Practice Address - Country:US
Practice Address - Phone:845-635-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical