Provider Demographics
NPI:1821438938
Name:YOUSUF, ABU (PA)
Entity Type:Individual
Prefix:MR
First Name:ABU
Middle Name:
Last Name:YOUSUF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 9TH AVE
Mailing Address - Street 2:#3E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-4025
Mailing Address - Country:US
Mailing Address - Phone:917-254-6657
Mailing Address - Fax:
Practice Address - Street 1:4114 9TH AVE
Practice Address - Street 2:#3E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-4025
Practice Address - Country:US
Practice Address - Phone:917-254-6657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010978363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical