Provider Demographics
NPI:1992829824
Name:ATM YOUSUF PHYSICIAN PC
Entity Type:Organization
Organization Name:ATM YOUSUF PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-777-1112
Mailing Address - Street 1:862 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5844
Mailing Address - Country:US
Mailing Address - Phone:718-777-1112
Mailing Address - Fax:
Practice Address - Street 1:862 WESTBURY RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5844
Practice Address - Country:US
Practice Address - Phone:718-777-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE1283OtherRR MEDICARE GROUP#
NY04075OtherMEDICARE GHI
NYP00273382OtherRR MEDICARE
NY01916150Medicaid
NYWET801Medicare PIN
NYH03485Medicare UPIN