Provider Demographics
NPI:1962850511
Name:YOUSSEF, MARY EZZAT
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EZZAT
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 4TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3244
Mailing Address - Country:US
Mailing Address - Phone:347-733-1916
Mailing Address - Fax:929-292-2329
Practice Address - Street 1:7510 4TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3244
Practice Address - Country:US
Practice Address - Phone:347-733-1916
Practice Address - Fax:929-292-2329
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist