Provider Demographics
NPI:1851098933
Name:MARY YOUSSEF MD
Entity Type:Organization
Organization Name:MARY YOUSSEF MD
Other - Org Name:MARY YOUSSEF, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-857-0988
Mailing Address - Street 1:61 N MAPLE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3232
Mailing Address - Country:US
Mailing Address - Phone:201-857-0988
Mailing Address - Fax:
Practice Address - Street 1:61 N MAPLE AVE STE 304
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3232
Practice Address - Country:US
Practice Address - Phone:201-857-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health