Provider Demographics
NPI:1255878427
Name:YOUSSEF, HANY (PA)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:
Last Name:YOUSSEF
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 1:650 VICTORY BLVD
Mailing Address - Street 2:6K
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3553
Mailing Address - Country:US
Mailing Address - Phone:732-770-2071
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVENUE
Practice Address - Street 2:DEPARTMENT OF GENERAL SURGERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020437363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical