Provider Demographics
NPI:1952630964
Name:YOUSSEF, SUMMER (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 48TH ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1014
Mailing Address - Country:US
Mailing Address - Phone:212-355-5550
Mailing Address - Fax:
Practice Address - Street 1:18 E 48TH ST
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1014
Practice Address - Country:US
Practice Address - Phone:212-355-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013372-1363A00000X
NJ25MP00222000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant