Provider Demographics
NPI:1598140949
Name:MY DOCTOR YOUSSEF MEDICAL PLLC
Entity Type:Organization
Organization Name:MY DOCTOR YOUSSEF MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:YOUSSEF-AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-869-1542
Mailing Address - Street 1:103-11 68TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-869-1542
Mailing Address - Fax:347-642-9859
Practice Address - Street 1:103-11 68TH DRIVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:347-642-5315
Practice Address - Fax:347-642-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199752-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01625007Medicaid
NY01625007Medicaid