Provider Demographics
NPI:1750674230
Name:YOUSEFZADEH, PEGAH (DO)
Entity Type:Individual
Prefix:
First Name:PEGAH
Middle Name:
Last Name:YOUSEFZADEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PEGAH
Other - Middle Name:
Other - Last Name:RABIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1113
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:2 PRO HEALTH PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1111
Practice Address - Country:US
Practice Address - Phone:516-390-5760
Practice Address - Fax:516-390-5765
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine