Provider Demographics
NPI:1700029485
Name:YOUSEFZADEH, ELEAZER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEAZER
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 FRANKLIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1629
Mailing Address - Country:US
Mailing Address - Phone:516-222-0067
Mailing Address - Fax:516-222-0071
Practice Address - Street 1:1205 FRANKLIN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1629
Practice Address - Country:US
Practice Address - Phone:516-222-0067
Practice Address - Fax:516-222-0071
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08552400207RG0100X
NY273391-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology